【作者】 王学栋；

【导师】 张宗利；

【作者基本信息】 山东大学 ， 外科学， 2009， 硕士

【摘要】 目的研究肝动脉结扎(栓塞)术后肝脓肿形成的发病机制和诊治方法。方法对2001年1月至2008年6月我院普外科收治的11例肝动脉结扎(栓塞)致肝脓肿形成的发病机制和诊治方法进行回顾性研究。结果11例患者中,肝门部胆管癌4例,胆管细胞型肝癌4例,结肠癌术后肝转移1例,胰头癌2例;术中结扎左肝动脉1例,结扎右肝动脉4例,结扎肝固有动脉4例,肝固有动脉栓塞2例;行胆(肝)肠吻合9例。术后患者均形成肝脓肿,确诊脓肿形成时间为术后6—22天。11例均通过B超引导下穿刺抽脓,并给予抗炎、保肝及高能量营养支持等处理。其中9例一次治愈,另2例反复发作,多次穿刺,最终因肿瘤复发、肝功能衰竭死亡。结论肝动脉结扎(栓塞)与术后肝脓肿形成密切相关,肝脓肿形成的发病机制与肝动脉结扎致胆管上皮细胞缺血、缺氧、坏死、感染继发肝组织大面积感染坏死有关,尤其在行胆肠吻合术或伴有门静脉狭窄、癌栓等受侵犯的患者。术中应尽量保留肝动脉,受肿瘤侵犯者切除肝动脉后应行肝动脉重建,对于肿瘤浸润严重、远端肝动脉完全闭塞、无法直接行动脉重建的患者,可以行门静脉动脉化等其他动脉重建方式,以保证肝组织和胆管细胞的血供。一旦形成肝脓肿,B超引导下穿刺引流结合抗炎治疗是治疗肝脓肿的较好办法更多还原

【Abstract】 Objective: To study the mechanism、diagnosis and treatment of liver abscess formation after hepatic artery ligation (embolism) .Methods: The data of 11 cases of liver abscess formation after hepatic artery ligation ( embolism) were gathered and analyzed retrospectively from January ,2001 to June ,2008.Results: Among the 11 cases, there are 4 cases of hilar bile duct carcinoma、4 cases of bilecellular carcinomas、1 case of heptic metastasis after operation for cancer of colon、2 cases of carcinomas of head of pancreas. Left hepatic artery was ligated in 1 case, right hepatic artery in 4 cases, proper hepatic artery in 4 cases and proper hepatic artery was embolismed in 2 cases. Biliary-intestinal anastomosis was performed in 9 cases. Liver abscess developed in all the 11 cases. The time of liver abscess development was 6-22 days after operation. Treated with sonographic guided percutaneous puncture for clearing pus in coordination with sensitive antibiotics、liver function preservation and high nutrition support, 9 cases were cured and multiple liver abcess took place in the other 2 repeatedly.Conclusions: Hepatic artery ligation is of great importance to liver abscess formation. The mechanism is related with the ischemia、anoxia and necrosis of cells of bile duct epithelia caused by hepatic artery ligation, which leads to infection and necrosis of a big area of liver tissue, especially in patients with biliary-intestine anastomosis or cancerous embolus in portal vein. Hepatic artery should be reserved as far as possible during operation. If invaded, hepatic artery reconstruction should be performed. To those whose hepatic artery is severely invaded and of which the distal terminal is totally blocked, hepatic artery reconstruction is unavailable and some other types of artery reconstruction like portal vein arterialization (PVA) could be performed to guarantee the blood supply of liver tissue as well as bile duct cells. Once hepatic abscess formed, sonographic guided percutaneous puncture drainage in coordination with sensitive antibiotics、liver function preservation and high nutrition support is an effective measurement.更多还原