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Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.
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Reducing blood loss during hepateetomy is important.Intraoperative blood loss and liver damage of hepatectomy under the total hemihepatic vascular exclusion could be less than that under the other methods of vascular occlusion.It could be worth improving and applying further.This article review the latest studies to introduce the latest advancement in this area.
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Objective To evaluate the clinical values of selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas.Methods Forty patients with large hepatocellular carcinomas who underwent hepatectomy with selective hepatic inflow and outflow occlusion of tumor-bearing liver were retrospectively analyzed.Results All the 40 patients underwent hepatectomy successfully.The blood losts during the operation was 100-800 mL(average 360 mL).The operation time was 90-150 min(average 116 min).Intraoperative blood transfusion was not performed in twenty-five patients.All patients recovered completely and were discharged without liver function failure or other severe complications.There was no perioperative death.Conclusions Selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas is a safe and effective method with advantages of controlling hemorrhage,decreasing liver damage and gut barrier injury,avoiding air embolism and preventing metastasis.
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Objective: To evaluate the significance of occlusion of hemihepatic inflow plus major ipsilateral hepatic veins in anatomic hepatectomy. Methods: One hundred and two cases were divided into 3 groups for anatomic hepatectomy: Group A (hemihepatic inflow plus major hepatic vein occlusion, n=42), Group B (hemihepatic inflow occlusion, n=30)and Group C (Pringle maneuver, n=30). The amount of intraoperative bleeding, time of operation, postoperative liver function, liver function recovering and complications were compared. Results: The average amount of hemorrhage in Group A, Group B and Group C were(453.5?87.9)、(612.8?101.6)and(646.7?136.6)mL, respectively. The mean blood loss in Group A was significantly more than that in Group B and Group C (P0.05). The levels of serum alanine transaminase (ALT)and bilirubin of 3rd and 6th day of postoperation in Group A and Group B were significantly lower than that in Group C, while the level of serum albumin in Group A and Group B was significantly higher than that in Group C(P0.05). Incidence of ascites in Group C was significantly higher than in Group A and Group B (P