摘要
背景:在肝移植手术中,肝脏外科血流阻断技术很重要,它可减少术中出血,有利于肝功能恢复等优点。在肝脏外科技术的发展中,出现了各种优良的肝脏血流阻断技术,该技术领域至今仍是外科界的研究热点。目的:介绍了肝脏外科血流阻断技术种类,最新研究热点及进展。方法:以"Hepatectomy;Hepatic vascular exclusion;Advancement"及"肝切除术;血流阻断"为检索词,分别检索PubM ed数据库和万方医学网1999年1月至2014年1月相关文献。选择与入肝血流阻断、择性入肝血流阻断、全肝血流阻断及肝切除断面血流阻断技术相关的文献50篇文献进行分析探讨。结果与结论:肝脏血流阻断方法种类较多,最常用的是间歇入肝血流阻断法和半肝入肝血流阻断法。建议的适用原则是:1对于在肝脏边缘的病灶小于5 cm的患者,可考虑在不阻断肝脏血流的情况下进行手术。2局限于半肝内的病灶适合半肝入肝血流阻断法,尤其适合合并肝硬化的患者,保留半肝动脉入肝血流阻断法和绕肝提拉肝血流阻断法的也有相关的研究,认为在临床应用具有一定价值,但从目前来看二者的临床研究报道相对较少,有待进一步研究。3超过半肝或跨越两半肝(巨大病灶)的病灶适合用间歇入肝血流阻断法。4累及肝后下腔静脉和(或)肝静脉,或与第二、三肝门关系紧密的病灶适合用肝血流隔离法及其改良术式。5病灶体积较小局限于肝段内条件允许可考虑肝段血流阻断技术,还可用常规的半肝血流阻断法和入肝血流阻断法。根据病情的具体情况,选择适合的方法是减少出血、保证患者安全的关键。
BACKGROUND：Hepatic vascular exclusion is important for liver transplantation that can reduce blood loss and make for liver recovery. A variety of favorable hepatic vascular exclusion techniques occur in the development of liver surgery technology, which is stil a research hot in surgical study. OBJECTIVE：To introduce the latest research and the hot spot of hepatic vascular exclusion techniques. METHODS：A computer-based online search of PubMed and Wanfang databases for articles relevant to Pringle maneuve, total hepatic vascular exclusion, selective hepatic vascular exclusion and sectional vascular exclusion under hepatectomy published from January 1999 to January 2014. Totaly 50 articles were included in result analysis. RESULTS AND CONCLUSION：There are a variety of hepatic vascular exclusion technologies, and intermittent hepatic vascular occlusion and semihepatic vascular exclusion are used most commonly. The applicable principles are as folows： （1） Surgery without vascular exclusion is suitable for 〈 5 cm lesions at the liver edge. （2） Semi-hepatic vascular exclusion is fit for semi-hepatic lesions, especialy for patients accompanied by liver cirrhosis. Hepatic vascular exclusion with preservation of semi-hepatic artery and liver hanging maneuver are also reported to have a certain value in clinical practice stil need further studies. （3） Intermittent hepatic vascular exclusion is suitable for lesions over half a liver or spanning liver halves （huge lesions）. （4） Total hepatic vascular exclusion and its modified technologies are suitable for lesions involving the inferior vena cava and （or） hepatic vein, or lesions closely related to the second and third porta hepatis. （5） Segmental hepatic vascular exclusion is considered for smaler lesions confined to the liver segment under alowed conditions, but semi-hepatic vascular exclusion and Pringle maneuver can be also considered. Depending on patient’s conditions, to select the appropriate method is the key to reduce bleeding and to ensure patient safety.
出处
《中国组织工程研究》
CAS
CSCD
2014年第46期7503-7508,共6页
Chinese Journal of Tissue Engineering Research
