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Arantius韧带肝外阻断左肝静脉在腹腔镜左肝切除术中的应用

作者：李旭刚吴祖光张耀明温治强刘高敏吴涌宏李丽华

单位：梅州市人民医院肝胆外二科广东梅州514031

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出版年,卷(期):页码：2017,9(1):40-44

摘要：

摘要：目的探讨Arantius韧带肝外阻断左肝静脉在腹腔镜左肝切除术中的应用价值。方法选取2014
年1月至2016年6月本院收治的56例腹腔镜左肝切除术患者为研究对象，随机分为2组，每组28例。对
照组给予传统左肝静脉处理；观察组给予Arantius韧带肝外阻断左肝静脉。比较两组患者围术期各指
标、术后并发症发生率及手术前后肝功能及应激反应指标水平。结果与对照组相比，观察组患者术
中出血量少，恢复胃肠功能时间及住院时间均较短，差异有统计学意义（t值分别为17.905、2.017、
3.908，P值分别为＜ 0.001、0.042、0.019），两组患者手术时间和肝血流阻断时间差异无统计学意义
（t值分别为0.965、0.482，P值分别为0.104、0.517）。观察组患者左肝静脉阻断前后血流动力学指标
（外周循环阻力、肺循环阻力、平均动脉压）更为平稳，在不同时间点（切断前、切断后5分钟、切
断后10分钟）与对照组对比，差异均有统计学意义（P均＜ 0.05）。观察组和对照组的术后并发症发
生率分别为3.57%和17.85%，差异有统计学意义（χ 2 = 5.973，P = 0.014）。手术后两组患者肝功能及
及应激指标水平均上升，观察组上升幅度显著小于对照组（P均＜ 0.05）。结论通过Arantius韧带肝
外阻断左肝静脉应用于腹腔镜左肝切除术有助于减少患者术中出血量、降低术后并发症、保护肝功
能，还具有恢复快、创伤小等诸多优点，值得推广。

Abstract: Objective To explore the application value of left hepatic vein occlusion through Arantius ligament
in laparoscopic left liver resection. Methods Total of 56 cases underwent laparoscopic left liver resection in
our hospital from January 2014 to June 2016 were randomly selected and divided into two groups, with 28
cases in each group. Patients in control group were treated with traditional left hepatic vein occlusion, while
patients in observation group were treated with left hepatic vein occlusion through Arantius ligament. Various
indexes in perioperative period, postoperative complications, liver function before and after operation and the
level of stress reaction indexes were compared. Results Compared with control group, the bleeding amount
during operation in observation group was less, time of gastrointestinal function recovery and hospital stay
were shorter, the differences were statistically significant (t = 17.905, 2.017, 3.908; P ＜ 0.001, 0.042, 0.019).
The operation time and hepatic blood flow blocking time had no statistically significant differences between
two groups (t = 0.965, 0.482; P = 0.104, 0.517). Hemodynamic parameters including peripheral vascular
resistance, pulmonary vascular resistance and mean arterial pressure in observation group before and after left
hepatic vein occlusion were more stable, there were significant differences between two groups at different
time points (P ＜ 0.05). The postoperative complication rate in the observation group and control group were
3.57% and 17.85%, respectively, the difference was statistically significant (χ 2 = 5.973, P = 0.014). After
surgery, indexes of liver function and stress increased in both groups, but the increase in the observation group
were significantly lower than those in control group (P ＜ 0.05). Conclusions Left hepatic vein occlusion

through Arantius ligament in laparoscopic left liver resection can reduce the amount of bleeding during
operation and postoperative complications, and protect liver function. It also has a quick recovery, small
trauma and other advantages. It is worthy to be popularized.

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