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目的探讨前入路半肝血流阻断法在原发性巨块型肝癌行规则性肝切除术的应用价值。方法回顾性分析8年半间笔者应用前入路半肝血流阻断法行规则性肝切除术15例的原发性巨块型肝癌伴肝硬化患者的临床资料。观察术中失血量、输血量、术后3 d总引流量、肝功能及并发症的指标。结果术中平均失血量为(820±346)mL;术中输血9例,平均输血量(533±176)mL;术后3 d总引流量平均为(426±285)mL;血清ALT,TBIL,PA及PT各指标值在术后7 d内有10例(10/15)恢复正常或接近正常,术后14 d内有13例(13/15)恢复到正常水平或接近正常。术后发生胸腔积液2例,难治性腹水1例,无肝衰竭和围手术期死亡病例。结论前入路半肝血流阻断法能有效控制术中出血,对残余肝功能损害小,术后恢复快,提高了伴有肝硬化巨块型肝癌的手术安全性。
Objective To investigate the value of anterior approach hemi-hepatic blood flow occlusion in the treatment of primary giant liver cancer. Methods The clinical data of 15 patients with primary giant hepatocellular carcinoma and cirrhosis who underwent hepatectomy before hepatectomy undergoing routine hepatectomy for 8 and a half years were retrospectively analyzed. Intraoperative blood loss, blood transfusion, total drainage 3 days after operation, liver function and complications were observed. Results The mean intraoperative blood loss was (820 ± 346) mL. Blood transfusion was achieved in 9 cases (533 ± 176) ml during operation. The average drainage volume was (426 ± 285) mL at 3 days after operation. Serum ALT, TBIL , PA and PT index values returned to normal or nearly normal in 10 cases (10/15) within 7 days after operation, and 13 cases (13/15) returned to normal or nearly normal within 14 days after operation. Postoperative pleural effusion in 2 cases, refractory ascites in 1 case, no liver failure and perioperative deaths. Conclusions The anterior approach of hemihepatic blood flow blocking can effectively control intraoperative bleeding, has less damage to residual liver function and quick recovery after operation, and improves the operation safety of hepatocellular carcinoma with liver cirrhosis.