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摘要：
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摘要：目的 探讨半肝血流阻断加选择性肝静脉控制在原发性肝癌合并肝硬化患者肝叶切除中的应用
效果。方法 选取2013年10月至2016年10月于四川大学华西广安医院诊治的原发性肝癌合并肝硬化患
者116例为研究对象，所有患者均行肝切除术。采用随机数字表法将患者分为两组，每组58例，对照
组采用Pringle法第一肝门阻断入肝血流，观察组采用半肝血流阻断加选择性肝静脉控制，记录两组
患者的手术指标（手术时间、术中出血量、阻断时间、术后住院时间）及并发症，比较手术前和出
院前1 d两组患者的肝功能指标（ALT、TBil、ALP、AST、PA、CHE和ALB）。结果 对照组患者术
中出血量、阻断时间和术后住院时间分别为（478.0 ± 34.6）ml、（16.3 ± 1.8）min、（21.5 ± 2.3）d，
观察组患者上述指标分别为（310.2 ± 21.5）ml、（18.5 ± 2.0）min、（18.9 ± 1.6）d，差异有统计
学意义（P ＜ 0.05）。两组患者出院前1 d ALT、TBil、ALP和AST水平均较手术前显著升高，PA、
CHE和ALB水平较手术前显著降低（P ＜ 0.05）。出院前1 d，对照组患者ALT、TBil、ALP和AST
水平均显著高于观察组 [（327.9 ± 31.2）U/L vs（254.7 ± 16.0）U/L、（42.6 ± 5.1）μmol/L vs（29.8 ±
2.4）μmol/L、（324.7 ± 21.3）U/L vs（268.5 ± 17.2）U/L、（308.7 ± 23.9）U/L vs（237.4 ± 14.3）U/L]，
PA、CHE和ALB水平显著低于观察组 [（182.3 ± 15.4）mg/L vs（232.6 ± 13.7）mg/L、（5.6 ± 0.4）U/L vs
（6.5 ± 0.3）U/L、（32.6 ± 2.1）g/L vs（37.9 ± 1.7）g/L]，差异有统计学意义（P ＜ 0.05）。对照组并发症
发生率为12.1%（7/58），显著高于观察组的1.7%（1/58），差异有统计学意义（χ 2 = 4.833，P = 0.028）。
结论 半肝血流阻断加选择性肝静脉控制在原发性肝癌合并肝硬化患者肝切除中的效果显著，可改善患者
肝功能并提高安全性。
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Abstract: Objective To investigate the application of semi-hepatic vascular occlusion combined with
selective hepatic vein control on liver resection of patients with primary liver cancer and liver cirrhosis.
Methods Total of 116 patients with primary liver cancer and liver cirrhosis in West China - Guang’an
Hospital, Sichuan University from October 2013 to October 2016 were selected, all patients were given liver
resection. Patients were divided into two groups by random number table method, 58 cases in each group.
Patients in control group were given first hepatic portal occlusion by Pringle, and patients in observation
group were given semi-hepatic vascular occlusion combined with selective hepatic vein control. The surgical
indications (operative time, intraoperative blood loss, blocking time, postoperative hospitalization time) and
complications were recorded and the liver function indexes were compared between the two groups before
operation and 1 day before discharge. Results The intraoperative blood loss, blocking time and postoperative
hospitalization time of patients in control group were (478.0 ± 34.6) ml, (16.3 ± 1.8) min and (21.5 ± 2.3)
d, respectively; the above indexes of patients in observation group were (310.2 ± 21.5) ml, (18.5 ± 2.0) min
and (18.9 ± 1.6) d, respectively, with statistically significant differences (P ＜ 0.05). The levels of ALT, TBil,
ALP and AST were significantly higher and the levels of PA, CHE and ALB were significantly lower in both
groups 1 d before discharge than those before operation (P ＜ 0.05). One day before discharge, the levels of
ALT, TBil, ALP and AST of patients in control group were significantly higher than those in observation group
[(327.9 ± 31.2) U/L vs (254.7 ± 16.0) U/L, (42.6 ± 5.1) μmol/L vs (29.8 ± 2.4) μmol/L, (324.7 ± 21.3) U/L vs
(268.5 ± 17.2) U/L, (308.7 ± 23.9) U/L vs (237.4 ± 14.3) U/L] and the levels of PA, CHE and ALB of patients
in control group were significantly lower than those in observation group [(182.3 ± 15.4) mg/L vs (232.6 ±
13.7) mg/L, (5.6 ± 0.4) U/L vs (6.5 ± 0.3) U/L, (32.6 ± 2.1) g/L vs (37.9 ± 1.7) g/L]. The differences were
statistically significant (P ＜ 0.05). The incidence of complications in control group was 12.1% (7/58), which
was significantly higher than that in observation group (1.7%, 1/58), with statistically significant difference
(χ 2 = 4.833, P = 0.028). Conclusions Semi hepatic vascular occlusion combined with selective hepatic vein
control have significant application effect in liver resection of patients with primary liver cancer and liver
cirrhosis, which can improve the patients’ liver function and safety.
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