van der Bilt J D W, Livestro D P, Borren A, van Hillegersberg R, Borel Rinkes I H M
Department of Surgery, University Medical Center, Utrecht, The Netherlands.
Dig Surg. 2007;24(6):423-35. doi: 10.1159/000108325. Epub 2007 Sep 13.
This study evaluated the frequency, the indications and techniques of vascular clamping during liver resection and during thermal destruction therapies, as currently used by hepatic surgeons throughout Europe.
A web-based questionnaire was distributed among 621 physicians, including all members of the European Hepato-Pancreato-Biliary Association and the European Surgical Association.
The overall response rate was 50%. During liver resection, vascular clamping is never applied by 10%, on indication by 71%, and routinely by 19%. Routine clamping is particularly performed by high-volume and senior surgeons and appears to be associated with longer ischaemia times. Intermittent inflow occlusion is the clamping method of choice for more than 65% of surgeons and total ischaemia times are usually limited to 15-30 min. During thermal ablation, vascular clamping is never used by 57%, on indication by 37%, and routinely by 7%; it is particularly applied for large tumours and for tumours close to large vessels, and ischaemia times are shorter.
Vascular clamping during liver resection is frequently used; during thermal ablation it is preserved for larger tumours or tumours in the vicinity of large vessels. Complete inflow occlusion is the most frequently used technique, with a distinct preference for intermittent clamping.
本研究评估了欧洲肝脏外科医生目前在肝切除和热消融治疗过程中血管钳夹的频率、适应证及技术。
向621名医生发放了基于网络的调查问卷，其中包括欧洲肝胰胆协会和欧洲外科协会的所有成员。
总体回复率为50%。在肝切除过程中，10%的医生从不应用血管钳夹，71%根据适应证应用，19%常规应用。常规钳夹尤其由手术量大的资深外科医生进行，且似乎与更长的缺血时间相关。超过65%的外科医生选择间歇性血流阻断作为钳夹方法，总缺血时间通常限制在15 - 30分钟。在热消融过程中，57%的医生从不使用血管钳夹，37%根据适应证使用，7%常规使用；它尤其适用于大肿瘤和靠近大血管的肿瘤，且缺血时间较短。
肝切除过程中经常使用血管钳夹；热消融时则保留用于较大肿瘤或靠近大血管的肿瘤。完全血流阻断是最常用的技术，明显更倾向于间歇性钳夹。
