探讨右半肝血流阻断在肝右后叶解剖性切除术中的应用价值。

回顾性分析2010年1月至2015年2月在湖南省人民医院行肝右后叶解剖性切除术的81例患者临床资料。根据肝脏血流阻断方法将患者分为3组，其中右半肝血流阻断法（Ⅰ法）组26例，男12例，女14例；平均年龄（48±9）岁；右后叶区域阻断法（Ⅱ法）组34例，男15例，女19例；年龄（48±10）岁；Pringle法（Ⅲ法）组21例，男10例，女11例；年龄（48±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。Ⅰ法放置右半肝蒂阻断带备用，或解剖出肝右动脉及门静脉右支分别阻断。Ⅱ法在Ⅰ法基础上分离出肝右动脉右后支及门静脉右后支，结扎切断。Ⅲ法不解剖第一肝门。观察3组患者的手术时间、术中出血量、输血情况等情况。3组数据的比较采用单因素方差分析和LSD-t检验。

Ⅰ、Ⅱ、Ⅲ法组患者的手术时间分别为（168±52）、（216±39）、（193±43）min，Ⅰ法组的手术时间明显短于Ⅱ法组和Ⅲ法组（LSD-t=-4.093，-1.772；P<0.05）。Ⅰ、Ⅱ、Ⅲ法组患者的术中出血量分别为（200±62）、（403±38）、（303±37）ml，Ⅰ法组的术中出血量明显少于Ⅱ法组和Ⅲ法组（LSD-t=-15.671，-12.735；P<0.05）。

肝右后叶解剖性切除术中采用右半肝血流阻断控制出血安全、可行，能明显减少术中出血量，缩短手术时间，有利于降低手术风险。

To evaluate the application value of right hemihepatic blood flow occlusion in the anatomical right posterior lobectomy.

Clinical data of 81 patients undergoing anatomical right posterior lobectomy in Hunan Provincial People's Hospital between January 2010 and February 2015 were retrospectively analyzed. The patients were divided into three groups according to the methods of liver blood flow occlusion. In the right hemihepatic blood flow occlusion group (method Ⅰ group), there were 26 cases including 12 males and 14 females with a mean of (48±9) years. In the regional blood flow occlusion of right posterior lobe group (method Ⅱ group), there were 34 cases including 15 males and 19 females with a mean of (48±10) years. In the Pringle's maneuver group (method Ⅲ group), there were 21 cases including 10 males and 11 females with a mean of (48±10) years. The informed consents of all patients were obtained and the local ethical committee approval was received. In method Ⅰ group, the right hepatic pedicle occluding band was prepared for spare, or the right hepatic artery and the right branch of portal vein were dissected and occluded separately. In method Ⅱ group, the right posterior branch of right hepatic artery and the right posterior branch of portal vein were separated, ligated and resected on the basis of method Ⅰ. In method Ⅲ group, porta hepatis was not dissected. The operation time, intraoperative hemorrhage volume and blood transfusion were observed in three groups. Clinical data among three groups were compared by one-way ANOVA and LSD-t test.

The operation time in method Ⅰ group was (168±52) min, which was significantly shorter compared with (216±39) and (193±43) min in method Ⅱ and method Ⅲ group (LSD-t=-4.093, -1.772; P<0.05). The intraoperative hemorrhage volume in method Ⅰ group was (200±62) ml, which was significantly less compared with (403±38) and (303±37) ml in method Ⅱ and method Ⅲ group (LSD-t=-15.671, -12.735; P<0.05).

Right hemihepatic blood flow occlusion is a safe and feasible technique for controlling hemorrhage during the anatomical right posterior lobectomy, which significantly decreases the intraoperative hemorrhage volume, shortens operation time and reduces surgical risk.