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Objective To explore the application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion.Methods The retrospectively cross-sectional study was conducted.The clinicopathological data of 27 patients who received laparoscopic right-posterior lobe hepatectomy in the Sir Run Run Shaw Hospital of Zhejiang University from May 2007 to June 2017 were collected.The hepatocellular carcinoma,intrahepatic bile duct stone,hepatic hemangioma,focal nodular hyperplasia,cholangiocarcinoma and metastatic hepatic carcinoma were respectively detected in 13,4,4,4,1 and 1 patients.The laparoscopic right-posterior lobe hepatectomy were performed after regional blood flow occlusion.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative recurrence of patients with benign liver diseases and survival of patients with malignant liver tumors up to August 2017.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:27 patients underwent successful laparoscopic right-posterior lobe hepatectomy after regional blood flow occlusion,including 24 undergoing laparoscopic surgery and 3 undergoing conversion to open surgery due to difficult exposure under laparoscopy.Operation time,volume of intraoperative blood loss,recovery time of postoperative gastrointestinal function and time of postoperative abdominal drainage-tube removal were respectively 205 minutes (range,125-455 minutes),400 mL (range,50-2 000 mL),1 day (range,1-3 days) and 3 days (range,2-24 days).There was no postoperative hepatic failure,bile leakage and bleeding-induced reoperation.Of 4 patients with postoperative complications,1 with wound infection was improved by regular dressing,1 with deep venous thrombosis of the lower extremity was improved by anticoagulant therapy and 2 with pulmonary infection were improved by anti-infective supporting treatment.The duration of postoperative hospital stay in 27 patients was 9 days (range,5-26 days).(2) Follow-up situations:26 of 27 patients were followed up for 2-121 months,with a median time of 17 months,and 1 patient with benign liver disease lost to follow-up.During the follow-up,11 patients with benign liver disease had no recurrence,the tumor-free and overall survival times of 15 patients with malignant liver tumors were respectively 13 months (range,5-57 months) and 14 months (range,5-57 months).Conclusion Laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion is safe and feasible,with a lower risk of liver failure and better clinical efficacies.
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Objective To investigate the optimal pressure range produced by two types of air pressure cuff in order to block superficial vein to assist thrombolytic therapy for deep venous thrombosis (DVT) of lower extremity,which can effectively dissolve the thrombus as well as improve the patient's comfort,and to provide useful basis for the implementation of individualized and standard nursing process.Methods A total of 80 patients with lower limb DVT were randomly and equally divided into the modified air pressure cuff group (study group,n=40) and the traditional standard sphygmomanometer cuff group (control group,n=40).Thrombolytic therapy by using continuous intravenous infusion of urokinase via the dorsalis pedis vein with infusion pump was performed in all patients of both groups.The daily dose of urokinase was the same.The pressure value to obstruct lower limb superficial venous blood flow,that was the airbag pressure value when the deep veins of lower limb became visualized on venography,was determined.Leg swelling fade-away rate,mean thrombus clearance rate and patient's comfort degree,etc.were calculated,and the results were compared between the two groups.Results In the study group,the pressure value to block superficial venous blood flow of lower limb was 65-75 mmHg with a mean of (70±5) mmHg;which in the control group was 60-85 mmHg with a mean of (70±10) mmHg.The Leg swelling fade-away rate,the mean thrombus clearance rate determined at different time points,and the patient's comfort degree of the study group were remarkably better than those of the control group (P＜0.05).Conclusion Compared to the use of traditional standard sphygmomanometer cuff,the use of modified air pressure cuff to block the lower limb superficial venous blood flow can obtain better thrombolytic effect,meanwhile,the patients can get high comfort degree in the therapeutic process.
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Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.
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Objective To investigate the intra-and postoperative course of patients undergoing laparoscopic liver resections under intermittent total pedicle occlusion (IPO),hemihepatic vascular occlusion (HVO),and selective vascular occlusion(SVO).Methods Retrospective analysis the data of 41 cases of laparoscopic liver resection were conducted in three groups of patients under different occlusion methods,including 15 cases of intermittent total pedicle occlusion (IPO),12 cases of hemihepatic vascular occlusion (HVO) and 14 cases of selective vascular occlusion (SVO).Intraoperation blood loss,operation time,conversion to open operation,changes in postoperative liver function,hospital stays and complications were compared among the three methods.Results There was no operative death in any of the 41 patients.There was no conversion to open surgery.Generally,there was no significant difference among the three groups in blood loss,clamping time or operative time.Ten patients had postoperative complication and all were cured.The effect on liver function for Gro-HVO and Gro-SVO was significantly less severe than that for Gro-IPO (P ＜ 0.05) after operation.Conclusions Both HVO and SVO are feasible and safe in laparoscopic hepatectomy(LH),and have advantage in reducing liver remnant ischemia injury and modality rate over IPO.HVO is easy to do for left lateral lobe or resection of the left half of the liver.SVO is suitable for right lobe resection.
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Objective To evaluate regional blood flow occlusion (RBFO) in hepatectomy for liver neoplasms. Methods In this study, hepatic tumors were resected under RBFO in 28 cases (RBFO group), and under Springle's technique (control group) in 24 cases. The Child-Pugh classifications of liver function were grade A in all patients. The ligature ribbon was put in liver parenchyma around tumor to block the blood supply before resecting the tumor under guiding of B sounography in RBFO group. Anesthesia time, blood loss and transfusion, hospitalization, change of liver function and complications were compared between the two groups. Results Blood loss, anesthesia time and postoperative hospital stay were (340±92) ml, (98.4±25.0) min, ( 10.2±2.3 ) d in RBFO group and (620±124) ml, ( 135.8±47.5 ) min, (16.5±5.1 ) d, respectively, in control group, differences were all significant between the two groups (P <0.01, t = 9.222,9.328 and 5.875, respectively). On post-op day 2, ALT (U/L) was (378.4±35.2) vs. (539.2±115.4) (t=7.012, P<0.01), TBIL (37.5±11.2) vs. (51.8±29) mmol/L(t=8.818, P<0.01),PT (17.4±2.4) vs. (20.4±2.8) see(t =4.16, P<0.01) in RBFO group and control group, respectively. ALT was (57.1±15.5) vs. (98.1±21.2) U/L(t =8.039),TBIL (25.4±4) vs. (46.3±13) mmol/L(t=8.085),PT (13.2±4.2) vs. (15.7±2.2) see (t=2.621)on post-op day 7 respectively, again the differences were all significant between the two groups (all P<0.01). Conclusion Regional blood flow occlusion is an effective technique to control blood loss during hepatectomy for liver neoplasms.
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BACKGROUND: Temporary occlusion of hepatic blood inflow and vascular exclusion are effective for reduction of intraoperative bleeding which is a major problem during hepatic resection. But it might be suggested that they resulted in hemodynamic, electrolyte and blood gas changes. This study was designed for investigating those changes during liver resection using portal triad clamping and/or right, left or both hepatic vein clamping. METHODS: Forty one patients, diagnosed as hepatoma and intrahepatic duct stone, were involved in this study. Duration of liver ischemia was 48.7+/-14.8 min. Hemodynamic variables, electrolytes and arterial blood gas were measured before portal triad clamping and at 10, 30 min after clamping, and 10, 30, and 120 min after declamping, and were compared with each other. Bicarbonate was given when its value was below 20 mEq/L. RESULTS: In the changes of hemodynamics, diastolic blood pressure was decreased significantly at 10 and 30 min after declamping compared with before clamping. In the changes of ABG and electrolytes, pH, bicarbonate and chloride ion were changed significantly at 10 min after clamping compared with before clamping. pH at 10 min after declamping was decreased more associated with increasing anion gap without change of the bicarbonate and increased PaCO2. CONCLUSION: From these results, hemodynamic changes are not remarkable but metabolic acidosis is occurred from 10 minutes after portal triad clamping and more acidotic change was developed at 10 min after declamping, immediate treatment of metabolic acidosis is needed.
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Humans , Acid-Base Equilibrium , Acidosis , Blood Pressure , Carcinoma, Hepatocellular , Constriction , Electrolytes , Hemodynamics , Hemorrhage , Hepatic Veins , Hydrogen-Ion Concentration , Ischemia , LiverABSTRACT
There is a direct relationship between the plasma concentration of the drugs and the magnitude of neuromuscular blockade in non-depolarizing neuromuscular blocking agents. But the classical pharmacokinetic data of succinylcholine have not been obtained because of the lack of an appropriate assay to detect plasma concentration hydrolyzed rapidly by pseudocholinesterase. The purposes of this study was to determine neuromuscular response from the release of minute interval of toumiquet occlusion after intravenous bolus adminstration of succinylcholine at one arm following blood flow occlusion at contralateral arm with pneumatic toumiquet. The twitch height of neuromuscular responses after adminisration of succinylcholine was completely depressed in the group(control) without occlusion, but 5.40+/-3.63% on 1 minute, 30.11+/-9.72% on 2 minutes, 85.00+/-4.19% on 4 minutes and 97.75+/-0.59% on 5 minutes after blood flow occlusion respectively. The onset time of maximum depression in each group was not significant different. At 5 minutes after succinylcholine given systemically, the twitch height was 8.35%, while it was 97.75% from tourniquet release on 5 minutes after blood flow occlusion. It is concluded that succinylcholine should be also related to plasma concentration in magnitude of neuromuscular block, and receptor binding(dissociation constant) more than plasma concentration in offset of neuromuscular blockade.
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Arm , Depression , Neuromuscular Blockade , Neuromuscular Blocking Agents , Plasma , Butyrylcholinesterase , Succinylcholine , TourniquetsABSTRACT
The muscle relaxants produce a dose-dependent effect that is usually mediated through an interaction between drug concentration in the vicinity of the receptors and receptor occupancy. Unfortunately, neither of these two variables is easy to measure the concentration of a relaxant drug at the neuromuscular junction, especeially in anesthetized humans, so indirect estimates must be made. Therefore, plasma concentration of a relaxant drugs may be taken as a reasonable estimate of the concentration at the effector site related directly to the dose given and of the degree of deporalization at the acetylcholine receptors occupancy. Immediately after the intravenous bolus injection of succinylcholine, there is almost instantaneous mixing into blood and penetrating into the neuromuscular junction and hydrolyzed rapidly by an enzyme within one or two circulation of succinylcholine in the body, and is so rapid that it is generally not detectable with conventional venous blood sampling within one or two minute intervals. This study conform the response of the time related plasma concentration of succinylcholine dose given by nerve stimulation. The twitch response of the adductor pollicis muslce was monitored using supramaximal TOF stimulation of the ulnar nerve at the left wrist by ABM (Datex Co.) and twitch response was recorded from release of tourniquet at 1, 2, 3 and 4 minutes after succinylcholine was given into the right arm after blood flow was occlude with tourniquet at left upper arm (study group) and from administration of succinylcholine without blood flow occlusion (control group). Conclusively the time duration from release of tourniquet 1, 2, 3 and 4 minutes after injection of succinylcholine to 75% T(1) recovery were 73.2%, 31.5%, 15.2% and 0% of the non-occluded arm respectively. Comparing with over 90% depression of twitch height until 4 minute after succinylcholine given, plama concentration at 4 minute after succinylcholine given (study group) did not make any significantly change of twitch height (p>0.05).