摘要
目的比较肝静脉止血带阻断法与 Satinsky 钳阻断法在第二肝门区肿瘤切除术中的应用。方法 2003年1月至2006年6月,采用肝静脉阻断法切除第二肝门区肿瘤180例,根据肝静脉阻断方法的不同,分为止血带阻断法(n=95)及 Satinsky 钳阻断法(n=85),止血带阻断法中将右肝静脉和/或左、中肝静脉共干分离出并绕止血带,收紧止血带将肝静脉血流阻断。Satinsky 钳阻断法中将右肝静脉和/或左、中肝静脉共干的前壁及两侧壁分离出,不分离肝静脉的后壁,用 Satinsky 钳沿腔静脉表面纵向夹闭肝静脉。比较两组术中及术后情况。结果两组一般情况、手术时间、术中肝热缺血时间、术中出血量及术后并发症发生率无明显差别,而肝静脉分离时间 Satinsky 钳阻断组明显短于止血带阻断组(6.2±2.4)min 与(18.3±6.2)min。止血带组中有1例右肝静脉、4例左、中肝静脉共干由于肿瘤压迫无法分离出而改为 Satinsky 钳阻断。1例左、中肝静脉共干分离时后壁破裂出血也改为 Satinsky 钳阻断。结论两组防止肝静脉出血的作用相似,但 Satinsky 钳阻断法较止血带阻断法操作更简便、安全。
Objective To compare the effects of hepatic vein occlusion with tourniquet and Satinsky clamp in resecting liver tumor involving the second hepatic portal. Methods From Jan 2003 to Jun 2006, 180 patients underwent major liver resection with the selective hepatic vascular exclusion （SHVE）. According to methods of hepatic vein occlusion, they were divided into two groups： Occlusion with tourniquet （tourniquet group, n =95 ） and occlusion with Satinsky clamp （Satinsky clamp group, n = 85）. In tourniquet group, the hepatic veins were encircled and occluded with tourniquet, and in Satinsky clamp group, the hepatic veins were not encircled and clamped directly with Satinsky clamp. Data regarding the intraoperative and postoperative courses of the patients were analyzed. Results There was no difference between the two groups regarding the operating time, ischemia time, intraoperative blood loss and postoperative complications rate. The dissecting time of hepatic veins was significantly shorter in Satinsky group （6.2 ±2. 4 min vs 18. 3±6.2 min）. In the tourniquet group, five hepatic veins （ one right hepatic vein and four common trunk of left-middle hepatic veins） could not be dissected and encircled because of the tumors involving the cava hepatic junction. Another patient＇s common trunk of left-middle hepatic vein was inadvertently lacerated during the dissection. Hepatic veins in these 6 patients were occluded with Satinsky clamp successfully. Conclusion Occlusion with Satinsky clamping is safer and easier procedure than tourniquets in the resection of liver tumor involving the second porta hepatis.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第12期888-891,共4页
Chinese Journal of General Surgery
关键词
肝肿瘤
肝切除术
肝静脉
静脉阻断
Liver neoplasms
Hepatectomy
Hepatic vein
Vascular exclusion
