肝血流阻断的方法及实施策略

本文主要介绍各种肝血流阻断的方法及各种方法的选择策略。持续性肝门阻断是较古老和简单的肝血流控制方法，目前仍被外科医生广泛的应用。间歇性肝门阻断、半肝血流阻断和保留腔静脉通畅的全肝血流阻断主要适用于肝实质异常的患者，全肝血流阻断操作复杂，并且有10％～20％的患者不能耐受阻断期间血液动力学变化，但是对于需要进行广泛下腔静脉重建的肝脏手术非常适合，保留腔静脉通畅的全肝血流阻断方法适用于涉及肝静脉重建或局限性下腔静脉重建的手术。肝脏手术中肝血流阻断方法的选择，应根据病变位置、肝脏病理变化程度、患者心血管情况以及术者和麻醉医师的经验和习惯等情况综合考虑而定。

Application of Various Techniques of Hepatic Vascular Control

The various techniques of hepatic vascular control are presented, focusing on the indications and drawbacks of each. The Pringle maneuver is the oldest and simplest of these methods and is still favored by many surgeons. Intermittent application of the Pringle maneuver and hemihepatic occlusion or inflow occlusion with extraparenchymal control of major hepatic veins is particularly indicated for patients with abnormal parenchyma. Total hepatic vascular exclusion is associated with considerable morbidity and hemodynamic intolerance in 10% to 20% of patients. It is absolutely indicated only when extensive reconstruction of the inferior vena cava （IVC） is warranted. Major hepatic veins/and limited IVC reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins. Each hepatic vascular control technique has its place in liver surgery, depending on tumor location, underlying liver disease, patient cardiovascular status, and most important, the experience of the surgical and anesthesia team.