【摘要】 目的 復習肝切除術中肝臟血流阻斷技術的研究進展。方法 對相關文獻進行分析與綜述。結果
肝臟血流阻斷方法多,最常用的和研究最多的是半肝(或選擇性) 血流阻斷法和間歇性入肝血流阻斷法,有損傷肝
靜脈和(或) 腔靜脈風險時啟用肝血流隔離法,極少采用全肝血流阻斷法和其他方法。結論 根據病情,巧妙選用
肝血流阻斷技術,可減少肝切除術中出血和保證患者安全。
引用本文： 文天夫,嚴律南. 肝切除術中肝臟血流阻斷技術的研究進展. 中國普外基礎與臨床雜志, 2008, 15(4): 299-302. doi: 復制
版權信息： ?四川大學華西醫院華西期刊社《中國普外基礎與臨床雜志》版權所有，未經授權不得轉載、改編
| 1. | Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185. |
| 2. | Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41. |
| 3. | Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques [J]. Arch Surg, 2002; 137(12)∶1369. |
| 4. | 蒲青凡, 嚴律南, 孫碎康, 等. 圍手術期輸血與肝臟術后感染并發癥的關系 [J]. 中國普外基礎與臨床雜志, 2003; 10(2)∶144. |
| 5. | Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63. |
| 6. | Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541. |
| 7. | Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704. |
| 8. | Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533. |
| 9. | Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794. |
| 10. | 涂兵, 嚴律南, 劉智敏. 缺血預處理對大鼠移植肝臟缺血再灌注損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2002; 9(2)∶89. |
| 11. | Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843. |
| 12. | Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480. |
| 13. | Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161. |
| 14. | Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454. |
| 15. | 陳孝平， 吳在德， 葉啟發， 等. 常溫下阻斷入肝血流行肝切除術81例臨床觀察 [J]. 中華外科雜志，1991; 29(2)∶84. |
| 16. | Belghiti J, Noun R, Malafosse R, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study [J]. Ann Surg, 1999; 229(3)∶369. |
| 17. | Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833. |
| 18. | Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169. |
| 19. | Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058. |
| 20. | Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949. |
| 21. | Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155. |
| 22. | 鄭光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途徑 [J]. 中國實用外科雜志，1989; 9（11）∶595. |
| 23. | 鄭光琪. 肝門區域血管阻斷切除肝臟腫瘤63例報告 [J]. 華西醫科大學學報，1992; 23（4）∶424. |
| 24. | 鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區域血管的肝段切除術133例報告 [J]. 肝膽外科雜志, 1995; 32（3）∶162. |
| 25. | 嚴律南， 袁朝新， 張肇達， 等. 應用半肝血流阻斷行肝葉切除術29例報告 [J]. 中華外科雜志，1994; 32（1）∶35. |
| 26. | Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376. |
| 27. | Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482. |
| 28. | Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265. |
| 29. | Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582. |
| 30. | Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20. |
| 31. | Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237. |
| 32. | 賴佳明, 梁力建, 黎東明. 肝血流阻斷在原發性肝癌切除術中的應用 [J]. 中國普外基礎與臨床雜志, 1999; 6(4)∶213. |
| 33. | 吳孟超， 仲劍平， 張曉華， 等. 常溫下全肝血流阻斷的肝切除術 [J]. 中華外科雜志, 1981; 19(1)∶36. |
| 34. | Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689. |
| 35. | Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155. |
| 36. | Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276. |
| 37. | 嚴律南， 盧實春， 陳曉理， 等. 用生物泵行體外靜脈轉流下的肝切除術 [J]. 中華肝膽外科雜志，2000; 6（1）∶37. |
| 38. | Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535. |
| 39. | Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176. |
| 40. | 文天夫, 嚴律南, 李波, 等. 活體右半肝供體的安全性 [J]. 中華外科雜志, 2006; 44(3)∶149. |
| 41. | Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644. |
| 42. | 黃潔夫， 劉唐彬. 改進的肝臟原位低溫灌注無血切肝術 [J]. 中華外科雜志，1994; 32（1）∶28. |
| 43. | Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167. |
- 1. Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185.
- 2. Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41.
- 3. Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques [J]. Arch Surg, 2002; 137(12)∶1369.
- 4. 蒲青凡, 嚴律南, 孫碎康, 等. 圍手術期輸血與肝臟術后感染并發癥的關系 [J]. 中國普外基礎與臨床雜志, 2003; 10(2)∶144.
- 5. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63.
- 6. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541.
- 7. Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704.
- 8. Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533.
- 9. Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794.
- 10. 涂兵, 嚴律南, 劉智敏. 缺血預處理對大鼠移植肝臟缺血再灌注損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2002; 9(2)∶89.
- 11. Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843.
- 12. Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480.
- 13. Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161.
- 14. Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454.
- 15. 陳孝平， 吳在德， 葉啟發， 等. 常溫下阻斷入肝血流行肝切除術81例臨床觀察 [J]. 中華外科雜志，1991; 29(2)∶84.
- 16. Belghiti J, Noun R, Malafosse R, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study [J]. Ann Surg, 1999; 229(3)∶369.
- 17. Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833.
- 18. Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169.
- 19. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058.
- 20. Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949.
- 21. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155.
- 22. 鄭光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途徑 [J]. 中國實用外科雜志，1989; 9（11）∶595.
- 23. 鄭光琪. 肝門區域血管阻斷切除肝臟腫瘤63例報告 [J]. 華西醫科大學學報，1992; 23（4）∶424.
- 24. 鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區域血管的肝段切除術133例報告 [J]. 肝膽外科雜志, 1995; 32（3）∶162.
- 25. 嚴律南， 袁朝新， 張肇達， 等. 應用半肝血流阻斷行肝葉切除術29例報告 [J]. 中華外科雜志，1994; 32（1）∶35.
- 26. Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376.
- 27. Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482.
- 28. Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265.
- 29. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582.
- 30. Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20.
- 31. Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237.
- 32. 賴佳明, 梁力建, 黎東明. 肝血流阻斷在原發性肝癌切除術中的應用 [J]. 中國普外基礎與臨床雜志, 1999; 6(4)∶213.
- 33. 吳孟超， 仲劍平， 張曉華， 等. 常溫下全肝血流阻斷的肝切除術 [J]. 中華外科雜志, 1981; 19(1)∶36.
- 34. Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689.
- 35. Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155.
- 36. Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276.
- 37. 嚴律南， 盧實春， 陳曉理， 等. 用生物泵行體外靜脈轉流下的肝切除術 [J]. 中華肝膽外科雜志，2000; 6（1）∶37.
- 38. Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535.
- 39. Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176.
- 40. 文天夫, 嚴律南, 李波, 等. 活體右半肝供體的安全性 [J]. 中華外科雜志, 2006; 44(3)∶149.
- 41. Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644.
- 42. 黃潔夫， 劉唐彬. 改進的肝臟原位低溫灌注無血切肝術 [J]. 中華外科雜志，1994; 32（1）∶28.
- 43. Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167.