Chouillard Elie K, Gumbs Andrew A, Cherqui Daniel
Department of Surgery, Centre Hospitalier Intercommunal, Poissy, France.
Ann Surg Innov Res. 2010 Mar 26;4:2. doi: 10.1186/1750-1164-4-2.
This article reviews the historical evolution of hepatic vascular clamping and their indications. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping.Specific techniques discussed and described include inflow clamping (Pringle maneuver, extra-hepatic selective clamping and intraglissonian clamping) and outflow clamping (total vascular exclusion, hepatic vascular exclusion with preservation of caval flow). The fundamental role of a low Central Venous Pressure during open and laparoscopic hepatectomy is described, as is the difference in their intra-operative measurements. The biological basis for ischemic preconditioning will be elucidated. Although the potential dangers of vascular clamping and the development of modern coagulation devices question the need for systemic clamping; the pre-operative factors and unforseen intra-operative events that mandate the use of hepatic vascular clamping will be highlighted.
本文回顾了肝血管阻断的历史演变及其适应证。将讨论部分和完全血管阻断的解剖学基础，以及持续和间歇性血管阻断的原理。所讨论和描述的具体技术包括入流阻断（普林格尔手法、肝外选择性阻断和肝门部Glisson系统阻断）和出流阻断（全血管隔离、保留腔静脉血流的肝血管隔离）。描述了开放和腹腔镜肝切除术中低中心静脉压的重要作用及其术中测量的差异。将阐明缺血预处理的生物学基础。尽管血管阻断的潜在风险和现代凝血设备的发展对全身阻断的必要性提出了质疑，但将强调术前因素和不可预见的术中事件，这些因素决定了肝血管阻断的使用。
