目的：比较不同肝血流阻断方式在肝癌合并肝硬化患者肝切除术中的应用效果。方法选取2009年10月~2014年6月在重庆市綦江区人民医院肝胆外科行肝脏切除术的肝癌合并肝硬化患者64例，随机分为全肝入肝血流阻断组（对照组）和半肝入肝血流阻断组（实验组），每组各32例。观察两组患者肝血流阻断时间、术中出血量及术后住院时间，记录两组患者手术前后血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBIL）；血红蛋白（Hb）等肝功能指标，并比较其术后并发症发生情况。结果两组患者肝血流阻断时间、术中出血量及术后住院时间比较[实验组（19.8±4.1）min、（429.3±36.7）mL、（16.3±3.5）d比对照组（18.7±5.7）min、（458.5±39.2）mL、（16.3±3.5）d]差异均无统计学意义（均P>0.05）。两组术前ALT、AST、TBIL、Hb等指标比较，差异均无统计学意义（均P>0.05）；实验组患者术后ALT[（48.23±11.36）U/L]、AST[（49.78±11.92）U/L]、TBIL[（109.25±34.73）μmol/L]指标水平低于对照组术后[ALT（75.23±13.26）U/L、AST（87.54±17.63）U/L、TBIL（192.32±71.25）μmol/L]，Hb[（101.13±24.03）g/L]水平高于对照组[（85.37±20.35）g/L]，差异均有统计学意义（均P<0.05）。两组患者均未发生大出血、休克、肝衰竭等。实验组患者术后出现腹水1例、消化道出血1例、肺部感染2例、胆瘘2例，总发生率为18.75%；对照组患者出现腹水2例、腹腔感染1例、肺部感染2例、胆瘘2例，总发生率为21.88%。两组并发症发生率比较，差异无统计学意义（P>0.05）。结论半肝入肝血流阻断法用于肝癌合并肝硬化患者有利于促进肝功能的恢复，且其并发症少，值得临床推广应用。%Objective To compare the application effect of different ways of hepatic vascular exclusion on hepatectomy of patients with hepatocellular carcinoma and cirrhosis. Methods From October 2009 to June 2014, in Department of Hepatobiliary Surgery, Qijiang People's Hospital of Chongqing City, 64 patients with hepatocellular carcinoma and cir-rhosis undergoing hepatectomy were selected and randomly divided into the omni-hepatic vascular occlusion group (control group) and semi-epatic vascular occlusion group (experiment group), according to the order of admission, with 32 cases in each group. The hepatic vascular exclusion time, intraoperative blood loss and postoperative hospital stay of two groups were observed, the serum alanine aminotransferase (ALT), aspartate amino transferase (AST), total bilirubin (TBIL), Haemoglobin B (Hb) and other indicators of liver function before and after operation in the two groups were recorded, and the conditions of postoperative complications were compared. Results The hepatic vascular exclusion time, intraoperative blood loss and postoperative hospital stay of the two groups were compared [experiment group (19.8±4.1) min,(429.3±36.7 )mL, (16.3±3.5) d vs control group (18.7±5.7) min, (458.5±39.2) mL, (16.3±3.5) d], the dif-ferences were not statistically significant (P>0.05). The indexes of ALT, AST, TBIL, Hb before the operation between the two groups were compared, the differences were not statistically significant (P> 0.05). After operation, the levels of ALT[(48.23±11.36) U/L], AST[(49.78±11.92) U/L], TBIL[(109.25±34.73)μmol/L] in the experiment group were all lower than those in control group [ALT (75.23±13.26) U/L, AST (87.54±17.63) U/L, TBIL (192.32±71.25) μmol/L], while the level of Hb in experiment group [(101.13±24.03) g/L] was higher than that of control group [(85.37±20.35) g/L], the differences were statistically significant (P< 0.05). Both groups had no massive haemorrhage, shock, hepatic failure. After operation, there were one case of ascites, one case of gastrointestinal bleeding, two cases of lung infection, two cases of biliary fistula in the experiment group, the total incidence was 18.75%; while there were two cases of ascites, one case of abdominal infection, two cases of lung infec-tion, two cases of biliary fistula in the control group, the total incidence was 21.88%. The incidence of complications between the two groups had no statistically significant difference (P> 0.05). Conclusion Semi-epatic vascular occlu-sion is useful to promote the recovery of hepatic function, and the complications are less, which is worthy of clinical promotion and application.
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