Selective exclusion of hepatic outflow and inflow for giant hepatic hemangioma resection / 中华普通外科杂志

Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People's Hospital from 2004. 1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp.Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.

Endovascular treatment of Budd-Chiari syndrome with occlusion of hepatic veins / 中华普通外科杂志

Objective To evaluate endovascular treatment of Budd-Chiari syndrome(BCS)with occlusion of hepatic veins.Methods Retrospective analysis on the clinical materials of 32 BCS cases with occlusion of hepatic veins was made.Four cases received inferior vena cava(IVC)angioplasty or stent implant and splenorenal shunt;Transfemoral vein or transjugular hepatic vein angioplasty was performed in 10 cases,and percutaneous transhepatic recanalization combined with transjugular and/or transfemoral vein angioplasty of hepatic veins was performed in 16 cases,respectively.Two cases failed therapy attempt.Results A failure to find the main hepatic vein in percutaneous transhepatic venography lead to the abandent of therapy in 2 cases.Hepatic vein angioplasty and IVC angioplasty was successful in the other 30 cases.The pressure of hepatic vein decreased from(43±8)cm H_2O to(16±4)cm H_2O(t=21.23,P<0.01).The symptoms were obviously relieved,ascites disappeared,abdominal distension palliated,chest and abdominal wall varicose veins collapsed one week after endovascular treatment.During perioperative procedure,2 cases with liver puncture bleeding were cured by laparotomy.The follow-up duration was 5 months to 65 months and mean(26.0±2.0)months.There was no stent migration and hepatic vein restenosis and occlusion.Chest and abdominal wall varicose veins disappeared and esophagus phlebeurysma were ameliorated as shown by esophageal barium series.There were no pulmonary embolism and death.Conclusions The procedure of endovascular treatment of BCS with occlusion of hepatic veins is simple,mini-traumatic and effective.

Application of combined hemihepatic infow and hepatic veins occlusion in major hepatectomy / 中国普通外科杂志

Objective To evaluate the effect of application of combined hemihepatic inflow and hepatic veins occlusion in major liver resection.Methods The clinical data of 46 cases of large hepatic carcinoma who underwent liver resection were surveyed retrospectively.The hepatic pedicle of affected side and hepatic veins were dissected and controlled initially,then hepatectomy was performed under the condition of vascular exclusion of the affected side of liver.Results All the 46 cases suffered from hepatocellular carcinoma.The average size of the tumors was 8.3 cm(6-15 cm) in diameter.One main hepatic vein was invaded by tumor in 20 cases and 2 main hepatic veins were invaded by tumor in 14 cases.Among the 46 hepatectomies,right hemihepatectomy was performed in 16,right posterior lobe hepatectomy in 14,and left hemihepatectomy in 16 cases.The mean occlusion time of the hemihepatic pedicle was 30 min(10-45 min),and occlusion time of the hepatic veins was 20 min(10-30 min).The average blood loss was 540 ml(300-1 500 mL).Postoperative complications occurred in 14 cases,and all recovered after treatment.There was no mortality in this series.Conclusions Combined hemihepatic inflow and hepatic veins occlusion in major hepatectomy is a safe,effective and practical vascular exclusion method which can effectively reduce the blood loss and the incidence of the liver function failure.