Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.
Br J Surg. 2011 Sep;98(9):1284-90. doi: 10.1002/bjs.7567. Epub 2011 Jun 2.
The aim of this study was to evaluate the influence of the duration of hepatic vascular inflow clamping (Pringle time) on the survival of patients with any type of liver background (not only cirrhosis) undergoing liver resection for hepatocellular carcinoma (HCC).
Patients who underwent liver resection between April 2000 and December 2008 for HCC using the Pringle manoeuvre were identified retrospectively from an institutional database and divided into two groups: group 1 had a Pringle time of 60 min or less, and group 2 a Pringle time of more than 60 min. Univariable and multivariable analyses were performed to identify predictors of postoperative survival. Kaplan-Meier analysis was used to compare overall survival between the groups.
A total of 357 patients were enrolled; 242 patients had a Pringle time of 60 min or less (group 1), and 115 patients had a Pringle time of more than 60 min (group 2). Patients in group 2 had a shorter overall survival than those in group 1 (P = 0·010). Univariable analyses showed that type of HCC (primary versus recurrent), maximum tumour diameter, hepatic venous infiltration, platelet count, serum protein induced by vitamin K absence or antagonist II level, blood loss (700 ml or less versus more than 700 ml), duration of operation (300 min or less versus more than 300 min) and Pringle time (60 min or less versus more than 60 min) were predictive of postoperative survival. Multivariable analysis indicated that only Pringle time was associated with postoperative survival (odds ratio 1·83, 95 per cent confidence interval 1·08 to 3·10; P = 0·024).
Longer Pringle time is an important predictor of shorter postoperative survival in patients undergoing liver resection for HCC.
本研究旨在评估肝门阻断时间（Pringle 时间）对任何类型肝背景（不仅是肝硬化）患者行肝癌切除术的生存影响。
回顾性地从机构数据库中确定了 2000 年 4 月至 2008 年 12 月期间因 HCC 行肝切除术且采用 Pringle 手法的患者，并将其分为两组：组 1 的 Pringle 时间为 60 分钟或更短，组 2 的 Pringle 时间超过 60 分钟。进行单变量和多变量分析以确定术后生存的预测因素。采用 Kaplan-Meier 分析比较两组之间的总生存率。
共纳入 357 例患者；242 例患者的 Pringle 时间为 60 分钟或更短（组 1），115 例患者的 Pringle 时间超过 60 分钟（组 2）。组 2 的总生存时间短于组 1（P=0.010）。单变量分析显示，HCC 类型（原发性与复发性）、最大肿瘤直径、肝静脉浸润、血小板计数、维生素 K 拮抗剂 II 诱导的血清蛋白、出血量（700ml 或更少与超过 700ml）、手术时间（300 分钟或更短与超过 300 分钟）和 Pringle 时间（60 分钟或更短与超过 60 分钟）是术后生存的预测因素。多变量分析表明，只有 Pringle 时间与术后生存相关（优势比 1.83，95%置信区间 1.08 至 3.10；P=0.024）。
对于行肝癌切除术的患者，较长的 Pringle 时间是术后生存时间较短的重要预测因素。
