肝臟雙懸吊技術(shù)及肝下下腔靜脈阻斷在肝切除術(shù)中的應(yīng)用研究
發(fā)布時(shí)間：2018-11-15 17:36
【摘要】：目的：評估大肝癌通過肝臟雙懸吊技術(shù)前入路法右半肝切除是否比傳統(tǒng)方法在手術(shù)安全性和遠(yuǎn)期生存結(jié)果方面具有優(yōu)勢。 方法：選取自2009年10月至2014年10月124例行右半肝切除的大肝癌患者進(jìn)行前瞻性隨機(jī)對照研究。患者被隨機(jī)分為兩組,一組使用肝臟雙懸吊技術(shù)前入路法右半肝切除(n=60,肝細(xì)胞癌39例,結(jié)直腸癌肝轉(zhuǎn)移10例,肝內(nèi)膽管細(xì)胞癌11例)、另一組使用傳統(tǒng)方法右半肝切除(n=64,肝細(xì)胞癌42例,結(jié)直腸癌肝轉(zhuǎn)移12例,肝內(nèi)膽管細(xì)胞癌10例)。肝臟雙懸吊技術(shù)前入路法核心在于沿下腔靜脈右側(cè)肝實(shí)質(zhì)與右腎上腺之間的肝后間隙作隧道,放置兩根懸吊帶,同時(shí)在肝臟游離前完成出入肝血流控制、肝實(shí)質(zhì)離斷。將兩組手術(shù)安全性和遠(yuǎn)期生存結(jié)果進(jìn)行對比分析。 結(jié)果：兩組均無圍手術(shù)期死亡病例,在肝細(xì)胞癌患者中,術(shù)中失血量、需要輸血的人數(shù)及斷肝時(shí)間懸吊組較非懸吊組顯著降低(p0.05),腫瘤切緣陽性率兩組無明顯差異,術(shù)后肝功能不全、腹水等的發(fā)生率懸吊組較非懸吊組傾向于減少,但差異不顯著。結(jié)直腸癌肝轉(zhuǎn)移患者中,斷肝時(shí)間懸吊組較非懸吊組顯著減少(p0.05),腫瘤切緣陽性率、術(shù)中失血量、需要輸血的人數(shù)及術(shù)后并發(fā)癥發(fā)生率兩組無明.顯差異。肝內(nèi)膽管細(xì)胞癌患者中,斷肝時(shí)間在懸吊組有減少的趨勢,但無統(tǒng)計(jì)學(xué)差異,腫瘤切緣陽性率、術(shù)中失血量、需要輸血的人數(shù)及術(shù)后并發(fā)癥發(fā)生率均無明顯差異。肝細(xì)胞癌患者中,無瘤生存率兩組無差異,但總體生存率懸吊組顯著好于非懸吊組(P0.05)。然而,結(jié)直腸癌肝轉(zhuǎn)移、肝內(nèi)膽管細(xì)胞癌術(shù)后無瘤生存率和總體生存率并沒有顯著差異。 結(jié)論：肝臟雙懸吊技術(shù)前入路法與傳統(tǒng)方法相比在手術(shù)安全性及腫瘤遠(yuǎn)期生存方面具有一定的優(yōu)勢,這一點(diǎn)在肝細(xì)胞癌患者中表現(xiàn)更為突出,在肝內(nèi)膽管細(xì)胞癌患者中表現(xiàn)不明顯。針對肝細(xì)胞癌,它可以作為右半肝切除的首選方法。 背景和目的：控制出血始終都是肝切除術(shù)的首要問題。肝切除術(shù)中有效地控制出血可以改善預(yù)后。入肝血流來源的出血可以通過Prigle法肝門阻斷或者選擇性肝門阻斷來控制,但它不能有效控制肝靜脈系統(tǒng)的出血。而肝靜脈系統(tǒng)的出血與中心靜脈壓密切相關(guān)。本研究旨在探討肝切除時(shí)肝下下腔靜脈完全阻斷、部分阻斷降低中心靜脈壓的效果,進(jìn)而研究低中心靜脈壓對肝切除手術(shù)的影響,同時(shí)進(jìn)一步了解其適應(yīng)證及不良反應(yīng)。方法：我們回顧性研究了2012年9月-2014年9月52例行肝下下腔靜脈阻斷的肝切除患者,其中全阻斷組28例,半阻斷組24例,與2009年7月-2012年1月48例沒有行肝下下腔靜脈阻斷的患者進(jìn)行比較,比較兩組手術(shù)相關(guān)指標(biāo)(術(shù)中出血量、輸血量等)和術(shù)后并發(fā)癥等指標(biāo)。 結(jié)果：全阻斷組、半阻斷組及未阻斷組的術(shù)中出血量分別為：387.67±182.54ml,406.32±178.45ml,796.72±337.38ml,全阻斷組及半阻斷組術(shù)中出血量均明顯小于對照組(p0.05),中心靜脈壓低于對照組,而全阻斷組與半阻斷組兩者無明顯差異,且均不會(huì)影響血流動(dòng)力學(xué)及肝腎功能等血生化指標(biāo)的變化。 結(jié)論：肝下下腔靜脈進(jìn)行全阻斷或半阻斷均能達(dá)到理想的降低中心靜脈壓,從而可明顯減少切肝過程中肝靜脈系統(tǒng)的出血。對于術(shù)前中心靜脈壓偏高的患者可通過肝下下腔靜脈完全或部分阻斷降低中心靜脈壓而不會(huì)產(chǎn)生任何不良后果。相比而言,肝下下腔靜脈部分阻斷更具有血流動(dòng)力學(xué)方面的優(yōu)勢。
[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
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：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
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.7
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