摘要
为了提高肝段切除的安全性，我们开展了Ｏ─ＧＴＴ、酮体比例等测定来检测肝储备功能，预测手术风险，正确选择病人；通过阻断入肝血流所致肝缺血的损伤机制及其防治研究，阐明了丹参注射液能减轻复流后损伤；切除肋弓改善了大肝癌切除的手术显露；最突出的是根据肝门区域的解剖设计一套阻断肝门区域血管的方法，在切除肝段时能缩小断流时肝缺血范围，多保留有血运的肝段，可延长阻断血管时间到２ｈ从容切肝。经上述方法已施行多种肝脏病变（肝癌、肝内胆管癌、转移性肝癌、肝内结石、肝血管瘤等）的肝段切除、中央肝段切除、紧贴或环绕第二肝门的复合肝段切除和跳跃式肝段切除等１３３例。右肝入肝血管阻断分为右肝动脉和门静脉右干、门静脉右前支、门静脉右后支及右肝动脉相应分支阻断，时间最长达４ｈ８ｍｉｎ，３ｈ、２ｈ１５ｍｉｎ各１例，多数在６０～９０ｍｉｎ。在左肝分为门静脉左干、左外支，左内支门静脉及相应左肝动脉分支阻断，时间最长达８５ｍｉｎ，多数为３０～６０ｍｉｎ。术后合并症主要为上消化道出血。术后１个月死亡３例，手术死亡率２．３％。
patients with hepatocellular carcinoma, cholangiocarcinoma,hemangioma and intrahepatic cholethiliasis etc. under went variable kind of liver segmentectomy using the procedure of the regional hilar vascular occlusion (RHVO). The technique of RHVO may decrease the ischemic liver area,increase the safe duration of vascular occlusion, reduce the blood lose during the liver resection. The occlusion of the right trunk of portal vein (RPV) lasted more than 2 in 7 cases, more than 1 in 20,1 or less in 33; the posterior branch of RPV lasted 40￣85 mins in 12 cases, the anterior branch of RPV in 4 cases;occlusion of left trunk of portal vein (LPV) lasted for 35￣85mins in 10 cases,medial branch of LPV in 18 cases,lateral branch of LPV in 29 cases and caudal branch in 1 cases. The critical postoperative complication was upper gastrointestinal bleeding especially in patients with portal hypertention associated with cirrhosis.There were 3 postoperative deaths within a month after operation with a operative mortality of 2. 3%.
出处
《肝胆外科杂志》
1995年第3期162-165,共4页
Journal of Hepatobiliary Surgery
关键词
肝段切除
肝门区血管阻断
肝切除术
Regional hepatic hilar occlusion Hepatic Segmentectomy
