Continuous versus intermittent portal triad clamping for liver resection -: A controlled study
Continuous versus intermittent portal triad clamping for liver resection -: A controlled study
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DOI：
10.1097/00000658-199903000-00010
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发表时间：
1999-03-01
影响因子：
9
通讯作者：
Farges, O
中科院分区：
文献类型：
--
作者：
Belghiti, J;Noun, R;Farges, O
目的比较连续夹持（CPC）和间歇夹持（IPC）两种肝切除术患者的手术过程，总结背景资料夹持可以减少肝切除术过程中的出血量，但在正常和异常肝实质的肝细胞损伤和出血量控制方面，IPC比CPC在人肝切除术中的优势尚存争议。方法将86例肝切除术患者纳入一项前瞻性随机研究，比较CPC （n = 42）或IPC （n = 44）术中和术后病程，钳夹时间为15分钟，拆夹时间为5分钟。根据是否存在（脂肪变性> %和慢性肝病）或是否存在异常肝实质进一步分析数据。结果两组患者在年龄、性别、肝脏肿瘤性质、术前评估结果、行大、小肝切除术的比例、非肿瘤性肝实质性质等方面相似。IPC组肝横断术中出血量明显增高，CPC组肝实质异常亚组术后肝酶及血清胆红素水平明显增高。4例肝实质异常患者术后出现肝功能严重恶化，2例术后死亡。结论本临床对照研究清楚地表明，肝实质对IPC的耐受性优于CPC，特别是在肝实质异常患者中。
ObjectiveThe authors compared the intra- and postoperative course of patients undergoing liver resections under continuous pedicular clamping (CPC) or intermittent pedicular clamping (IPC),Summary Background DataReduced blood loss during liver resection is achieved by pedicular clamping, There is controversy about the benefits of IPC over CPC in humans in terms of hepatocellular injury and blood loss control in normal and abnormal liver parenchyma.MethodsEighty-six patients undergoing liver resections were included in a prospective randomized study comparing the intra- and postoperative course under CPC (n = 42) or IPC (n = 44) with periods of 15 minutes of clamping and 5 minutes of unclamping. The data were further analyzed according to the presence (steatosis >20% and chronic liver disease) or absence of abnormal liver parenchyma.ResultsThe two groups of patients were similar in terms of age, sex, nature of the liver tumors, results of preoperative assessment, proportion of patients undergoing major or minor hepatectomy, and nature of nontumorous liver parenchyma. Intraoperative blood loss during liver transsection was significantly higher in the IPC group, in the CPC group, postoperative liver enzymes and serum bilirubin levels were significantly higher in the subgroup of patients with abnormal liver parenchyma. Major postoperative deterioration of liver function occurred in four patients with abnormal liver parenchyma, with two postoperative deaths. All of them were in the CPC group,ConclusionsThis clinical controlled study clearly demonstrated the better parenchymal tolerance to IPC over CPC, especially in patients with abnormal liver parenchyma.