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目的探讨单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中的应用价值。方法回顾性分析46例巨块型肝癌通过预先解剖、控制患侧入肝血流联合阻断出肝血流行切肝术患者的临床资料。结果 46例患者均为原发性肝癌,肿瘤平均直径8.3 cm(6～15 cm),肿瘤侵犯1根主肝静脉20例,侵犯2根主肝静脉14例。行右半肝切除16例,右后叶肝切除14例,左半肝切除16例。平均患侧入肝血流阻断时间30 min(10～45 min),平均肝静脉阻断时间20 min(10～30 min)。行肝静脉修补5例。平均术中出血量540 mL(300～1 500 mL)。全组术后发生并发症14例次,均经治疗后痊愈,无死亡病例。结论单侧入肝血流联合肝静脉阻断技术在复杂肝切除术中能明显减少术中出血,降低术后肝功能衰竭发生率,是一种安全、可行实用的血流阻断技术。
Objective To investigate the value of unilateral hepatic blood flow combined with hepatic vein occlusion in complicated hepatectomy. Methods A retrospective analysis was performed on 46 patients with hepatocellular carcinoma, which were pre-dissected and controlled to hepatic blood flow in the affected side. Results 46 patients were primary hepatocellular carcinoma with an average diameter of 8.3 cm (6-15 cm). The tumor invaded one main hepatic vein in 20 cases and invaded two main hepatic veins in 14 cases. Right hemihepatectomy was performed in 16 patients, right hepatectomy in 14 patients, and left hemihepatectomy in 16 patients. The average time of hepatic blood flow blocking in the affected side was 30 min (10-45 min), and the mean hepatic vein occlusion time was 20 min (10-30 min). Hepatic vein repair in 5 cases. The average intraoperative blood loss was 540 mL (300 to 1 500 mL). There were 14 cases of postoperative complications in the whole group, all recovered after treatment and no deaths occurred. Conclusion Unilateral hepatic arterial blood flow combined with hepatic vein occlusion can significantly reduce intraoperative blood loss and reduce the incidence of hepatic failure after complicated hepatectomy. It is a safe, feasible and practical method for blocking blood flow.