Intermittent regional hepatic vascular inflow occlusion for laparoscopic right anterior sectionectomy / 中华肝胆外科杂志

ABSTRACT

Objective:To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods:From January 2014 to December 2018, 54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital, Soochow University were recruited into this study. The patients were 40 to 60 years old, and 27 were males and 27 females. Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients (the intermittent occlusion group). The remaining patients underwent Pringle’s maneuvre (the Pringle group). Postoperative liver function, intraoperative blood loss, intraoperative blood transfusion, operation time and postoperative complications between the two groups were compared.Results:Intraoperative hemorrhage and blood transfusion of the Pringle group (534±42)ml, (2.88±0.54)U were significantly higher than the intermittent occlusion group (374±21)ml, (1.86±0.29)U (all P<0.05). The operation time of the Pringle group was significantly shorter than the intermittent occlusion group ( P<0.05). Two patients developed CO 2 embolism in each group, which led to 2 patients in the intermittent occlusion group being converted to open operations. Postoperative hepatic function (except albumin) of the intermittent occlusion group was significantly better than the Pringle group, while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group (all P<0.05). Six patients (25.0%) developed postoperative complications in the intermittent occlusion group versus 8 (26.7%) in the Pringle group ( P>0.05). Conclusion:Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment, and shortened hospital stay. However, it required higher operation skills and it should gradually be promoted.