• 【摘要】　目的　復(fù)習(xí)肝切除術(shù)中肝臟血流阻斷技術(shù)的研究進(jìn)展。方法　對(duì)相關(guān)文獻(xiàn)進(jìn)行分析與綜述。結(jié)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(fēng)險(xiǎn)時(shí)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(jié)論　根據(jù)病情,巧妙選用肝血流阻斷技術(shù),可減少肝切除術(shù)中出血和保證患者安全。;

【摘要】　目的 　復(fù)習(xí)肝切除術(shù)中肝臟血流阻斷技術(shù)的研究進(jìn)展。方法 　對(duì)相關(guān)文獻(xiàn)進(jìn)行分析與綜述。結(jié)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(fēng)險(xiǎn)時(shí)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(jié)論 　根據(jù)病情,巧妙選用
肝血流阻斷技術(shù),可減少肝切除術(shù)中出血和保證患者安全。

引用本文： 文天夫,嚴(yán)律南. 肝切除術(shù)中肝臟血流阻斷技術(shù)的研究進(jìn)展. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(4): 299-302. doi: 復(fù)制

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(yán)律南, 孫碎康, 等. 圍手術(shù)期輸血與肝臟術(shù)后感染并發(fā)癥的關(guān)系 [J]. 中國(guó)普外基礎(chǔ)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(yán)律南, 劉智敏. 缺血預(yù)處理對(duì)大鼠移植肝臟缺血再灌注損傷的保護(hù)作用 [J]. 中國(guó)普外基礎(chǔ)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(fā)， 等. 常溫下阻斷入肝血流行肝切除術(shù)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(guó)實(shí)用外科雜志，1989; 9（11）∶595.
23. 　鄭光琪. 肝門區(qū)域血管阻斷切除肝臟腫瘤63例報(bào)告 [J]. 華西醫(yī)科大學(xué)學(xué)報(bào)，1992; 23（4）∶424.
24. 　鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區(qū)域血管的肝段切除術(shù)133例報(bào)告 [J]. 肝膽外科雜志, 1995; 32（3）∶162.
25. 　嚴(yán)律南， 袁朝新， 張肇達(dá)， 等. 應(yīng)用半肝血流阻斷行肝葉切除術(shù)29例報(bào)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(fā)性肝癌切除術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)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(shù) [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(yán)律南， 盧實(shí)春， 陳曉理， 等. 用生物泵行體外靜脈轉(zhuǎn)流下的肝切除術(shù) [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(yán)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(jìn)的肝臟原位低溫灌注無(wú)血切肝術(shù) [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. 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. 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. 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. 4. 　蒲青凡, 嚴(yán)律南, 孫碎康, 等. 圍手術(shù)期輸血與肝臟術(shù)后感染并發(fā)癥的關(guān)系 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2003; 10(2)∶144.
  5. 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. 6. 　Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541.
  7. 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. 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. 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. 10. 　涂兵, 嚴(yán)律南, 劉智敏. 缺血預(yù)處理對(duì)大鼠移植肝臟缺血再灌注損傷的保護(hù)作用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002; 9(2)∶89.
  11. 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. 12. 　Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480.
  13. 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. 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. 15. 　陳孝平， 吳在德， 葉啟發(fā)， 等. 常溫下阻斷入肝血流行肝切除術(shù)81例臨床觀察 [J]. 中華外科雜志，1991; 29(2)∶84.
  16. 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. 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. 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. 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. 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. 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. 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(guó)實(shí)用外科雜志，1989; 9（11）∶595.
  23. 23. 　鄭光琪. 肝門區(qū)域血管阻斷切除肝臟腫瘤63例報(bào)告 [J]. 華西醫(yī)科大學(xué)學(xué)報(bào)，1992; 23（4）∶424.
  24. 24. 　鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區(qū)域血管的肝段切除術(shù)133例報(bào)告 [J]. 肝膽外科雜志, 1995; 32（3）∶162.
  25. 25. 　嚴(yán)律南， 袁朝新， 張肇達(dá)， 等. 應(yīng)用半肝血流阻斷行肝葉切除術(shù)29例報(bào)告 [J]. 中華外科雜志，1994; 32（1）∶35.
  26. 26. 　Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376.
  27. 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. 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. 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. 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. 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. 32. 　賴佳明, 梁力建, 黎東明. 肝血流阻斷在原發(fā)性肝癌切除術(shù)中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 1999; 6(4)∶213.
  33. 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(shù) [J]. 中華外科雜志, 1981; 19(1)∶36.
  34. 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. 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. 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. 37. 　嚴(yán)律南， 盧實(shí)春， 陳曉理， 等. 用生物泵行體外靜脈轉(zhuǎn)流下的肝切除術(shù) [J]. 中華肝膽外科雜志，2000; 6（1）∶37.
  38. 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. 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. 40. 　文天夫, 嚴(yán)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. 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. 42. 　黃潔夫， 劉唐彬. 改進(jìn)的肝臟原位低溫灌注無(wú)血切肝術(shù) [J]. 中華外科雜志，1994; 32（1）∶28.
  43. 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.