發(fā)布時(shí)間：2018-05-24 13:00

  本文選題：肝臟腫物 + 持續(xù)性第一肝門阻斷法��； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:探討四種不同入肝血流阻斷法在肝部分切除術(shù)中對(duì)術(shù)中出血量及術(shù)后肝功能的影響,進(jìn)而合理選擇肝門阻斷方法。方法:回顧性分析河北醫(yī)科大學(xué)第四醫(yī)院肝膽外科2014年1月至2016年1月收治的80例肝臟腫物患者的臨床資料。根據(jù)不同的入肝血流肝門阻斷方法將患者分為四組。持續(xù)性第一肝門血流阻斷組為A組(n=30):完全阻斷第一肝門,直至將肝臟腫瘤完整切除,但不超過20min。間歇性第一肝門血流阻斷組為B組(n=30):將第一肝門血流阻斷10min后恢復(fù)入肝血流5min,循環(huán)往復(fù)至腫瘤完整切除。半肝入肝血流阻斷組為C組(n=10):術(shù)中解剖肝十二指腸韌帶及肝門部,分離出肝固有動(dòng)脈、左右肝動(dòng)脈、門靜脈主干及其左右枝,采用病變所在半肝入肝血流持續(xù)性阻斷,健側(cè)半肝血流通暢的方法直至肝部分切除術(shù)順利完成。缺血預(yù)處理組為D組(n=10):肝部分切除手術(shù)前先阻斷入肝血流1-5min,恢復(fù)入肝血流5min,然后持續(xù)性阻斷第一肝門15min,間隔5min,循環(huán)往復(fù)直至肝部分切除術(shù)完成。比較四種不同肝門血流阻斷法患者的性別、年齡、腫瘤大小、手術(shù)前后肝功能(谷丙轉(zhuǎn)氨酶ALT,谷草轉(zhuǎn)氨酶AST,總膽紅素TB及白蛋白ALB)變化、術(shù)中出血量(ml)、平均阻斷時(shí)間(min)等。結(jié)果:四組患者在性別、年齡、術(shù)前肝功能(ALT、AST、TB、ALB)、腫瘤大小、是否存在乙肝病史、平均阻斷時(shí)間等方面均無統(tǒng)計(jì)學(xué)差異(P0.05)。C組出血量最少,B組出血量最多,B組與其他三組相比出血量明顯增多(P0.05)。四組患者術(shù)后ALT、AST、TB數(shù)值的比較:ALT:A組與B組比較,第1、3天A組比B組明顯增高(P0.05);A組與C組比較,第1、3、5、7天A組比C組明顯增高(P0.05);A組與D組比較,第1、3、5、7天均無統(tǒng)計(jì)學(xué)差異(P0.05);B組與C組比較,第3天B組比C組明顯增高(P0.05);B組與D組比較,第1天B組較D組明顯降低(P0.05);C組與D組比較,第1、3天C組較D組明顯降低(P0.05)。AST的變化與ALT相同。TB:A組與B、C組比較,第1、3天A組比B組、C組明顯增高(P0.05);A組與D組比較,第1、3、5天A組比D組明顯增高(P0.05);B組與C組比較,第3、5天B組比C組明顯增高(P0.05);B組與D組比較,第1天B組較D組明顯降低(P0.05),第5、7天B組比D組明顯增高(P0.05);C與D組比較,第1、3天C組較D組明顯降低(P0.05)。結(jié)論:1、肝部分切除術(shù)的患者術(shù)后肝功能的恢復(fù)與肝門阻斷方法的選擇有密切的關(guān)系。2、不同的肝門阻斷方法中,半肝入肝血流阻斷法對(duì)患者術(shù)后肝功能的影響最小,持續(xù)性肝門阻斷法對(duì)患者術(shù)后肝功能的影響最大。3、間歇性第一肝門阻斷法要優(yōu)于預(yù)處理組,但預(yù)處理組后期的肝功能恢復(fù)較間歇性第一肝門阻斷法快。4、間歇性第一肝門阻斷組出血量明顯多于其他組出血量。
[Abstract]:Objective: to investigate the effects of four different hepatic flow occlusion methods on intraoperative blood loss and liver function during partial hepatectomy, and to select a reasonable method of hepatic portal occlusion. Methods: the clinical data of 80 patients with hepatic tumor admitted from January 2014 to January 2016 in the fourth Hospital of Hebei Medical University were retrospectively analyzed. Patients were divided into four groups according to different hepatic portal occlusion methods. In group A, the first hepatic hilus was completely blocked until the tumor was removed completely, but not more than 20 min. The first hepatic portal blood flow occlusion group was group B: the first hepatic portal blood flow was blocked by 10min for 5 mins, and the circulatory flow returned to complete resection of the tumor. In group C, the ligaments and hilum of liver were dissected, and the proper hepatic artery, left and right hepatic artery, main portal vein and its branches were separated. The method of unobstructed hemihepatic blood flow was successfully completed until partial hepatectomy was performed. In the ischemic preconditioning group, the hepatic blood flow was blocked for 1 to 5 minutes before partial hepatectomy, and then continued to block the first hepatic hilum for 15 minutes, with an interval of 5 minutes, and circulatory reciprocating until partial hepatectomy was completed. Sex, age, tumor size, liver function (alt, AST, total bilirubin TB and Alb) before and after operation, intraoperative bleeding volume and mean blocking time were compared among the four different hepatic portal blood flow occlusion methods. Results: the patients in the four groups had the following characteristics: sex, age, liver function before operation, tumor size, liver function, and history of hepatitis B. There was no significant difference in the mean blocking time between group A and group B (P 0.05). Group C had the lowest amount of bleeding and group B had more blood loss than group B than the other three groups (P 0.05). Comparison of alt and ASTT TB levels in four groups after operation, the levels of TB in group A were significantly higher than those in group B on the first day of 3 days compared with those in group B, and significantly higher in group A than in group C on day 1, and in group A and group D on day 1, and in group A, group A and group D significantly higher than that in group C on the 7th day after operation. There was no statistical difference between group B and group C on the 7th day. On day 3, group B was significantly higher than group C, group B was significantly higher than group C and group D, and group B was significantly lower than group D on day 1. On the 1st day of the 3rd day, the changes of P0.05N. AST in group C were significantly lower than those in group D, and the changes in group A were significantly higher than those in group B and group C, and in group A and group C significantly higher than those in group A and group C on day 1 and day 3, respectively, and the changes in group A were significantly higher than those in group D on day 1, and in group B were significantly higher than those in group B and group C. On the 3rd day, group B was significantly higher than group C, group B was significantly lower than group D, group B was significantly lower than group D on day 1, group B was significantly higher than group D on day 5, group B was significantly higher than group D, and group C was significantly lower than group D on day 1 and day 3. Conclusion the recovery of liver function in patients with partial hepatectomy is closely related to the choice of hepatic portal occlusion methods. Among the different hepatic portal occlusion methods, hemihepatic flow occlusion has the least effect on postoperative liver function. Continuous hepatic portal occlusion had the greatest effect on liver function after operation. Intermittent first hepatic portal occlusion was better than pretreatment group. However, the recovery of liver function in the latter stage of pretreatment group was faster than that in the intermittent first hepatic portal occlusion method, and the amount of blood loss in the intermittent first hepatic portal occlusion group was significantly higher than that in the other groups.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R657.3

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