摘要
目的探讨在一定气腹压力范围内,进行一定时间的入肝血流阻断的安全性。方法回顾性分析2008年1月至2008年9月,中国医科大学附属盛京医院完成腹腔镜下肝海绵状血管瘤切除8例,其中男性3例,女性5例;年龄42-64岁,平均年龄47.9岁。均以持续入肝血流阻断法（CPM）阻断入肝血流,术中气腹压维持在1.33-2.00kPa（1015mmHg）,迅速完成切肝,监测术后第1、3、5天天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBiL）、白蛋白（ALB）变化,出院后随访半个月。结果全部顺利完成手术,无中转开腹,手术时间75-225min,平均手术时间138.8min（标准差48.7min）;第一肝门阻断时间25-45min,平均阻断时间32.0min（标准差6.0min）;术中出血量200-1500ml,平均出血量575.0ml（标准差562.5ml）。术后住院时间3-10d,平均住院时间6.0d（标准差2.2d）。出院后随访半个月,无一例患者发生肝功能衰竭,所有患者均无发热、黄疸,腹部超声检查未见腹腔积液;术后2周复查肝功能均基本恢复正常。结论在一定的气腹压力范围内,入肝血流阻断时间适当,CO2气腹下入肝血流阻断是安全的。
Objective To study the safety of hepatic blood inflow occlusion during a limited period under controlled intra-abdominal pressure.Methods Eightpatients with cavernous hemangioma of liver（male 3,female 5,aged 42-64 years,mean age 47.9 years）received laparoscopic hepatectomy from January to September in 2008 in Shengjing hospital.In these patients,their intra-abdominal pressure were kept among 1.33 ～ 2.00 kPa（10-15 mmHg）,hepatic vascular inflow occlusion achived by pringle＇s maneuver.The liver function including asparate aminotransferase（AST）,alanine aminotransferase（ALT）,total bilirubin（TBiL）,albumin（ALB）were measured postoperatively to analyze the liver damage;The patients were followed up of half-month.Results The laparoscopic hepatectomy was performed successfully in all patients without converting to open surgery.Their operation time were 75-225 minutes,mean（138.8 ± 48.7）minutes;hepatic portal blocking time were 25-45 minutes,mean（32.0 ± 6.0）minutes;intraoperative blood loss were 200-1 500 ml,mean（575.0 ± 562.5）ml;and the postoperative hospital length of stay was 3-10 days,mean（6.6 ± 2.2）days.All patients were followed up of half-month,no hepatic failure case was reported.Conclusion Under controlled intra-abdominal pressure and hepatic portal blocking time,hepatic blood inflow occlusion is a safety approach.
出处
《生物医学工程与临床》
CAS
2009年第5期418-421,共4页
Biomedical Engineering and Clinical Medicine
关键词
腹腔镜肝切除
超声刀
肝血管瘤
持续入肝血流阻断法
laparoscopic liver resection
ultrasonic scalpel
hepatic hemangioma
continuous pringle maneuver
