Capussotti L, Muratore A, Ferrero A, Massucco P, Ribero D, Polastri R
Division of Surgical Oncology, Institute of Cancer Research and Treatment, Candiolo, Turin, Italy.
Br J Surg. 2006 Jun;93(6):685-9. doi: 10.1002/bjs.5301.
The purpose of this study was to compare the perioperative outcome of liver resection with and without intermittent hepatic pedicle clamping.
Between June 2002 and June 2004, 126 consecutive patients with resectable liver tumours were randomized to undergo resection with (63 patients) or without (63 patients) intermittent hepatic pedicle clamping.
The transection time was significantly higher in the group without hepatic pedicle clamping. The blood loss per cm(2) was similar in the two groups: 2.7 ml/cm(2) in the group with versus 3.2 ml/cm(2) in group without hepatic pedicle clamping (P = 0.425). In the subset of patients with an abnormal liver, there were no differences in blood loss per transection surface: 3.1 ml/cm(2) in the group with versus 2.9 ml/cm(2) in the group without clamping (P = 0.829). The rate of blood transfusions was not higher in the non-clamping group. No differences were observed in the postoperative liver enzyme serum levels, the in-hospital mortality (one patient in each group) or the number of complications.
This study showed clearly that liver resection without hepatic pedicle clamping is safe, even in patients with a diseased liver.
本研究旨在比较有或无间歇性肝蒂阻断情况下肝切除的围手术期结果。
在2002年6月至2004年6月期间，126例连续的可切除肝肿瘤患者被随机分为两组，一组63例接受有间歇性肝蒂阻断的肝切除，另一组63例接受无间歇性肝蒂阻断的肝切除。
无肝蒂阻断组的肝断面离断时间显著更长。两组每平方厘米的失血量相似：有肝蒂阻断组为2.7毫升/平方厘米，无肝蒂阻断组为3.2毫升/平方厘米（P = 0.425）。在肝脏异常的患者亚组中，每个肝断面的失血量无差异：有肝蒂阻断组为3.1毫升/平方厘米，无阻断组为2.9毫升/平方厘米（P = 0.829）。无肝蒂阻断组的输血率并不更高。术后肝酶血清水平、院内死亡率（每组各1例患者）或并发症数量均无差异。
本研究清楚地表明，即使对于肝脏病变患者，无肝蒂阻断的肝切除也是安全的。
