肝脏双悬吊技术及肝下下腔静脉阻断在肝切除术中的应用研究
发布时间：2018-11-15 17:36
【摘要】：目的：评估大肝癌通过肝脏双悬吊技术前入路法右半肝切除是否比传统方法在手术安全性和远期生存结果方面具有优势。 方法：选取自2009年10月至2014年10月124例行右半肝切除的大肝癌患者进行前瞻性随机对照研究。患者被随机分为两组,一组使用肝脏双悬吊技术前入路法右半肝切除(n=60,肝细胞癌39例,结直肠癌肝转移10例,肝内胆管细胞癌11例)、另一组使用传统方法右半肝切除(n=64,肝细胞癌42例,结直肠癌肝转移12例,肝内胆管细胞癌10例)。肝脏双悬吊技术前入路法核心在于沿下腔静脉右侧肝实质与右肾上腺之间的肝后间隙作隧道,放置两根悬吊带,同时在肝脏游离前完成出入肝血流控制、肝实质离断。将两组手术安全性和远期生存结果进行对比分析。 结果：两组均无围手术期死亡病例,在肝细胞癌患者中,术中失血量、需要输血的人数及断肝时间悬吊组较非悬吊组显著降低(p0.05),肿瘤切缘阳性率两组无明显差异,术后肝功能不全、腹水等的发生率悬吊组较非悬吊组倾向于减少,但差异不显著。结直肠癌肝转移患者中,断肝时间悬吊组较非悬吊组显著减少(p0.05),肿瘤切缘阳性率、术中失血量、需要输血的人数及术后并发症发生率两组无明.显差异。肝内胆管细胞癌患者中,断肝时间在悬吊组有减少的趋势,但无统计学差异,肿瘤切缘阳性率、术中失血量、需要输血的人数及术后并发症发生率均无明显差异。肝细胞癌患者中,无瘤生存率两组无差异,但总体生存率悬吊组显著好于非悬吊组(P0.05)。然而,结直肠癌肝转移、肝内胆管细胞癌术后无瘤生存率和总体生存率并没有显著差异。 结论：肝脏双悬吊技术前入路法与传统方法相比在手术安全性及肿瘤远期生存方面具有一定的优势,这一点在肝细胞癌患者中表现更为突出,在肝内胆管细胞癌患者中表现不明显。针对肝细胞癌,它可以作为右半肝切除的首选方法。 背景和目的：控制出血始终都是肝切除术的首要问题。肝切除术中有效地控制出血可以改善预后。入肝血流来源的出血可以通过Prigle法肝门阻断或者选择性肝门阻断来控制,但它不能有效控制肝静脉系统的出血。而肝静脉系统的出血与中心静脉压密切相关。本研究旨在探讨肝切除时肝下下腔静脉完全阻断、部分阻断降低中心静脉压的效果,进而研究低中心静脉压对肝切除手术的影响,同时进一步了解其适应证及不良反应。方法：我们回顾性研究了2012年9月-2014年9月52例行肝下下腔静脉阻断的肝切除患者,其中全阻断组28例,半阻断组24例,与2009年7月-2012年1月48例没有行肝下下腔静脉阻断的患者进行比较,比较两组手术相关指标(术中出血量、输血量等)和术后并发症等指标。 结果：全阻断组、半阻断组及未阻断组的术中出血量分别为：387.67±182.54ml,406.32±178.45ml,796.72±337.38ml,全阻断组及半阻断组术中出血量均明显小于对照组(p0.05),中心静脉压低于对照组,而全阻断组与半阻断组两者无明显差异,且均不会影响血流动力学及肝肾功能等血生化指标的变化。 结论：肝下下腔静脉进行全阻断或半阻断均能达到理想的降低中心静脉压,从而可明显减少切肝过程中肝静脉系统的出血。对于术前中心静脉压偏高的患者可通过肝下下腔静脉完全或部分阻断降低中心静脉压而不会产生任何不良后果。相比而言,肝下下腔静脉部分阻断更具有血流动力学方面的优势。
[Abstract]:Objective: To evaluate whether the right half-hepatic resection of large liver cancer is superior to the traditional method in the operation safety and long-term survival results. Methods: A prospective randomized controlled trial of patients with large liver cancer from October 2009 to October 124, 2014 was selected. The patients were randomly divided into two groups. One group was divided into two groups. One group was divided into two groups: right half-hepatectomy (n = 60, hepatocellular carcinoma, 10 cases of colorectal cancer, 11 cases of intra-hepatic bile duct cell carcinoma), and the other group using the conventional method for right-right hepatectomy (n = 64, hepatocellular carcinoma 4). 2 cases of colorectal cancer, 12 cases of liver metastasis and 10 cases of intra-hepatic bile duct cell carcinoma example). The core of the anterior approach to the double-suspension technique of the liver is to tunnel the hepatic posterior gap between the right hepatic substance and the right adrenal gland along the right side of the lower vena cava, to place two suspension bands, and to complete the control of blood flow and blood flow in and out of the liver before the liver is free, and the liver parenchyma Dissection. Comparison of two groups of operative safety and long-term survival results Results: There was no perioperative death in the two groups. In the patients with hepatocellular carcinoma, the amount of blood loss, the number of transfusion and the suspension group of the suspension group were significantly lower than that of the non-suspension group (p0.05). There was no significant difference in the positive rate between the two groups. The incidence of incomplete liver function, ascites, and the like tends to be less than that of the non-suspension group, but The difference was not significant. In the patients with colorectal cancer, the suspension group was significantly reduced in the non-suspension group (p0.05), the positive rate of the tumor margin, the amount of blood loss during the operation, the number of blood transfusions and the postoperative complications. There is no difference between the two groups In the patients with intra-hepatic bile duct cell carcinoma, the time of hepatic failure was reduced in the suspension group, but there was no statistical difference, the positive rate of the margin of the tumor, the amount of blood loss during the operation, the number of blood transfusions and the incidence of postoperative complications. There was no significant difference in the patients with hepatocellular carcinoma, there was no difference between the two groups, but the overall survival rate was significantly better than that of the non-suspension group (P 0. 05). However, there was no tumor-free survival rate and overall survival rate in the liver of colorectal cancer and intra-hepatic bile duct cell carcinoma. Conclusion: The anterior approach of the double-suspension technique of the liver has a certain advantage in the safety of the operation and the long-term survival of the tumor compared with the traditional method. It is not clear in the patient. For hepatocellular carcinoma, it can be used as the right half Preferred methods for hepatectomy. Background and objectives: Control of bleeding all the time It's the first problem for hepatectomy. It's effective in hepatectomy. The control of the bleeding can improve the prognosis. The bleeding from the source of hepatic blood flow can be controlled by the Prigle method of hepatic door blocking or selective hepatic portal blocking, but it cannot be The effect controls the bleeding of the hepatic vein system. The aim of this study was to investigate the effect of low central venous pressure on the operation of hepatic resection, and to further study the effect of low central venous pressure on the operation of hepatic resection, and to further study the effect of low central venous pressure on the operation of hepatic resection. To understand the indications and adverse reactions of the liver. Methods: We retrospectively studied the patients with hepatic resection from September 2012 to September 52, 2014 under the condition of hepatic inferior vena cava blocking, including 28 cases of all-block group and 24 cases of semi-blocking group. A comparison was made between the two groups of operation-related indexes (intraoperative blood loss, amount of blood transfusion, Results: The total amount of blood loss in the whole block group, the semi-blocking group and the non-blocking group were: 387,67, 182.54ml, 406.32, 178.45ml, 796.72, 337.38ml, and the amount of blood loss in the whole block group and the half-block group was significantly lower than that of the control group (p0. 05), the central venous pressure was lower than that of the control group, and there was no significant difference between the whole block group and the semi-blocking group, and the hemodynamics was not affected. and the changes of blood biochemical indexes such as liver and kidney function and the like can be achieved. the bleeding of the hepatic vein system during the cutting of the liver is obviously reduced, and the patients with high venous pressure in the pre-operative central venous pressure can be completely or partially blocked by the lower vena cava under the liver. Low central venous pressure without any adverse consequences. In contrast, the lower vena cava in the live
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.7
[Abstract]:Objective: To evaluate whether the right half-hepatic resection of large liver cancer is superior to the traditional method in the operation safety and long-term survival results. Methods: A prospective randomized controlled trial of patients with large liver cancer from October 2009 to October 124, 2014 was selected. The patients were randomly divided into two groups. One group was divided into two groups. One group was divided into two groups: right half-hepatectomy (n = 60, hepatocellular carcinoma, 10 cases of colorectal cancer, 11 cases of intra-hepatic bile duct cell carcinoma), and the other group using the conventional method for right-right hepatectomy (n = 64, hepatocellular carcinoma 4). 2 cases of colorectal cancer, 12 cases of liver metastasis and 10 cases of intra-hepatic bile duct cell carcinoma example). The core of the anterior approach to the double-suspension technique of the liver is to tunnel the hepatic posterior gap between the right hepatic substance and the right adrenal gland along the right side of the lower vena cava, to place two suspension bands, and to complete the control of blood flow and blood flow in and out of the liver before the liver is free, and the liver parenchyma Dissection. Comparison of two groups of operative safety and long-term survival results Results: There was no perioperative death in the two groups. In the patients with hepatocellular carcinoma, the amount of blood loss, the number of transfusion and the suspension group of the suspension group were significantly lower than that of the non-suspension group (p0.05). There was no significant difference in the positive rate between the two groups. The incidence of incomplete liver function, ascites, and the like tends to be less than that of the non-suspension group, but The difference was not significant. In the patients with colorectal cancer, the suspension group was significantly reduced in the non-suspension group (p0.05), the positive rate of the tumor margin, the amount of blood loss during the operation, the number of blood transfusions and the postoperative complications. There is no difference between the two groups In the patients with intra-hepatic bile duct cell carcinoma, the time of hepatic failure was reduced in the suspension group, but there was no statistical difference, the positive rate of the margin of the tumor, the amount of blood loss during the operation, the number of blood transfusions and the incidence of postoperative complications. There was no significant difference in the patients with hepatocellular carcinoma, there was no difference between the two groups, but the overall survival rate was significantly better than that of the non-suspension group (P 0. 05). However, there was no tumor-free survival rate and overall survival rate in the liver of colorectal cancer and intra-hepatic bile duct cell carcinoma. Conclusion: The anterior approach of the double-suspension technique of the liver has a certain advantage in the safety of the operation and the long-term survival of the tumor compared with the traditional method. It is not clear in the patient. For hepatocellular carcinoma, it can be used as the right half Preferred methods for hepatectomy. Background and objectives: Control of bleeding all the time It's the first problem for hepatectomy. It's effective in hepatectomy. The control of the bleeding can improve the prognosis. The bleeding from the source of hepatic blood flow can be controlled by the Prigle method of hepatic door blocking or selective hepatic portal blocking, but it cannot be The effect controls the bleeding of the hepatic vein system. The aim of this study was to investigate the effect of low central venous pressure on the operation of hepatic resection, and to further study the effect of low central venous pressure on the operation of hepatic resection, and to further study the effect of low central venous pressure on the operation of hepatic resection. To understand the indications and adverse reactions of the liver. Methods: We retrospectively studied the patients with hepatic resection from September 2012 to September 52, 2014 under the condition of hepatic inferior vena cava blocking, including 28 cases of all-block group and 24 cases of semi-blocking group. A comparison was made between the two groups of operation-related indexes (intraoperative blood loss, amount of blood transfusion, Results: The total amount of blood loss in the whole block group, the semi-blocking group and the non-blocking group were: 387,67, 182.54ml, 406.32, 178.45ml, 796.72, 337.38ml, and the amount of blood loss in the whole block group and the half-block group was significantly lower than that of the control group (p0. 05), the central venous pressure was lower than that of the control group, and there was no significant difference between the whole block group and the semi-blocking group, and the hemodynamics was not affected. and the changes of blood biochemical indexes such as liver and kidney function and the like can be achieved. the bleeding of the hepatic vein system during the cutting of the liver is obviously reduced, and the patients with high venous pressure in the pre-operative central venous pressure can be completely or partially blocked by the lower vena cava under the liver. Low central venous pressure without any adverse consequences. In contrast, the lower vena cava in the live
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.7
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