探讨经肝门板半肝阻断在肝细胞肝癌（肝癌）切除术中的应用价值。

本组回顾性研究对象为2007年6月至2012年6月在广东佛山市第一人民医院行肝癌切除术的72例患者。患者均签署知情同意书，符合医学伦理学规定。按肝血流阻断方法将患者分为经肝门板半肝血流阻断组（半肝阻断组）和Pringle肝门血流阻断组（Pringle组）。半肝阻断组30例，男性25例，女性5例，中位年龄42岁；手术方式包括左半肝切除术8例，左外叶切除术2例，右半肝切除术12例，肝右前叶切除术3例，肝右后叶切除术5例。Pringle组42例，男性35例，女性7例，中位年龄45岁；手术方式包括左半肝切除术11例，肝左外叶切除术3例，右半肝切除术18例，肝右前叶切除术2例，右后叶切除术8例。记录手术时间、肝门阻断时间，术中出血量及术后住院时间，观察术后1、3、7 d血清丙氨酸转氨酶（ALT）、白蛋白（ALB）、总胆红素（TB）的变化及术后出血、肝衰竭、胆漏、腹水等并发症及死亡发生情况。采用t检验比较两组手术时间、肝门阻断时间、术中出血量、术后肝功能及术后住院时间的差异。

半肝阻断组和Pringle组患者手术时间分别为（221±51）min和（211±41）min，两组比较差异无统计学意义（t=1.576，P=0.122）；半肝阻断组患者肝门阻断时间为（34.5±3.4）min，明显长于Pringle组的（24.0±2.5）min（t=2.541，P=0.015）；半肝阻断组和Pringle组患者术中出血量分别为（466±91）ml和（403±80）ml，两组比较差异无统计学意义（t=1.013，P=0.331）。半肝阻断组患者术后1、3、7 d的血清ALB高于Pringle组，ALT、TB低于Pringle组，两组比较差异有统计学意义（均为P<0.05）。半肝阻断组术后住院时间为（6.7±1.3）d，Pringle组为（8.5±2.6）d，两组比较差异有统计学意义（t=2.447，P=0.018）。两组均无发生手术相关死亡及出血、肝衰竭等严重并发症。Pringle组术后1例发生胆漏，21 d后才拔除引流管，治愈；1例术后出现大量腹水，予以补充人血白蛋白及利尿治疗后消失。

在肝癌切除术中应用经肝门板半肝血流阻断具有肝功能损害轻、术后恢复快、并发症发生率低等优点，是一种安全、有效的控制肝脏血流的方法。

To investigate the application value of hemihepatic vascular occlusion through hilar plate during hepatectomy for patients with hepatocellular carcinoma.

Retrospective analysis was conducted in 72 patients with hepatocellular carcinoma who underwent hepatectomy from June 2007 to June 2012 in the First People’s Hospital of Foshan. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. All the patients were divided into hemihepatic occlusion group and Pringle maneuver group according to the method of vascular occlusion. Thirty cases(25 male, 5 female, mean age of 42 years) were included in the hemihepatic occlusion group, in which, hepatectomy was performed on the left half liver(n=8), left lateral lobes (n=2), right lobe(n=12), right anterior lobes (n=3), right posterior lobes (n=5), respectively. Forty-two cases(35 male, 7 female, mean age of 45 years) were included in the Pringle maneuver group, in which, hepatectomy was performed on the left half liver (n=11), left lateral lobes (n=3), right half liver(n=18), right anterior lobes (n=2), right posterior lobes (n=8), respectively. The time of operation, porta hepatis clamping, blood loss during operation, postoperative hospital stay were recorded. Alanine aminotransferase(ALT), albumin(ALB) and total bilirubin(TB) on day 1, 3, and 7 after operation were monitored. Mortality and postoperative complications including hemorrhage, hepatic failure, bile leakage and seroperitoneum were also detected. The t test was made to compare the difference between two groups in the time of operation, porta hepatis clamping, blood loss during operation, postoperative hepatic function and hospital stay.

The operation time of the hemihepatic occlusion group and Pringle maneuver group were (221±51) min and (211±41) min respectively. There was no significant difference between two groups (t=1.576, P=0.122) . The time of porta hepatis clamping in the hemihepatic occlusion group was (34.5±3.4) min, which was evidently longer than that of the Pringle maneuver group was (24.0±2.5) min (t=2.541, P=0.015). The blood loss during operation in two groups were (466±91) ml and (403±80) ml respectively. There was no significant difference (t=1.013, P=0.331) . The ALB on day 1, 3, and 7 after operation in the hemihepatic occlusion group were higher than that in the Pringle maneuver group while the ALT, TB were lower than those in the Pringle maneuver group. There was no significant difference between two groups (all in P<0.05). The hospital stay in two groups were (6.7±1.3) d and (8.5±2.6) d, which demonstrated significant difference (t=2.447, P=0.018) . No mortality, hemorrhage or hepatic failure was found in two groups. One case in the Pringle maneuver group suffered bile leakage after the operation and were cured by removing the drainage tube 21 days later. And 1 case suffered massive ascites and recovered by the use of albumin and diuretics.

The hemihepatic vascular occlusion through hilar plate in hepatectomy of hepatocellular carcinoma is a safe and effective technique for controlling the hepatic blood flow, with the advantage of less damage to liver function, quick recovery after operation and low incidence of complicatons.