Problems of precision hepatic surgery in nowadays / 中华消化外科杂志

With the era of precision hepatic surgery coming,the hepatic surgery has been promoted to brand-new level,which would be more accurate and meticulous.However,all those advances,such as super-thin computed tomography scan,three-dimensional imaging and the technology of threedimensional printing,have not promoted the clinic results for patients overtly.The optimal curative effect could be attained,if there is a perfect combination of operators' experience and those advanced imaging.For two issues,the time of vascular inflow occlusion and residual hepatic volume,operators could flexiblely use of clinic existing researches with surgical team and instruments according to the medical condition of patients.Precision hepatic surgery could be promoted to a higher level through constantly clinical research and innovations.

Impact of hepatic vascular inflow exclusion on postoperative arterial lactate level in patients undergoing hepatectomy / 中华普通外科杂志

Objective To investigate the impact of vascular inflow occlusion of the liver on arterial lactate level and pH value. Methods In this study, 68 patients who underwent hepatectomy from January 2006 to December 2008 were retrospectively studied. The patients were assigned to one of the three study groups according the vascular inflow status: clamping of portal vein and hepatic artery in the hepatic pedicle (n = 20), hemihepatectomy under total hemihepatic vascular exclusion (THVE, n = 22), and non-vascular occlusion (n = 26). Postoperative arterial blood gas analysis including systemic arterial lactate concentration, and liver and renal function tests were performed. Results Systemic arterial blood lactate levels significantly elevated in the portal clamping and THVE groups (5.53 ±2. 31 mmol/L and 5.62 ±2.52mmol/L, respectively), compared to the non-occlusion group (3. 37 ± 1.56 mmol/L, P < 0. 05) ;significant increase in arterial HCO3- level was observed in the THVE group in comparison to the nonocclusion group (19. 68 ± 3. 82) mmol/L vs. (21.65 ± 2. 48) mmol/L, (P < 0. 05). There were no significant differences as to the changes of pH values, liver and renal function tests between the three groups. Conclusions Vascular inflow deprivation may result in significantly increased arterial lactate level. Thus, intense surveillance of blood lactate level with prompt treatment is necessary to prevent postoperative hyperlactatemia and metabolic acidosis.