Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
J Hepatobiliary Pancreat Sci. 2012 Jan;19(1):15-8. doi: 10.1007/s00534-011-0451-0.
Control of blood loss is a serious problem during liver resection. Bleeding from the inflow system can be controlled by the Pringle maneuver. The time limit for clamping is up to 10-15 min. A shortcoming of the Pringle maneuver is that it causes blood congestion in the portal vein. To avoid this problem other techniques have been developed including selective vascular occlusion and selective clamping of segmental branches. Bleeding from the outflow system is closely related to central venous pressure (CVP). Lowering the CVP reduces blood loss; in particular, keeping CVP <5 cmH(2)O by anesthesiological management is a simple and effective way to reduce blood loss. CVP remains high in some cases despite anesthesiological efforts, but in these circumstances other techniques are available including inferior vena cava clamping below the liver and intraoperative blood salvage.
控制肝切除术中的出血是一个严重的问题。通过普雷令（Pringle）手法可以控制流入系统的出血。夹闭的时间限制可达 10-15 分钟。普雷令手法的一个缺点是会导致门静脉淤血。为了避免这个问题，已经开发了其他技术，包括选择性血管闭塞和节段性分支的选择性夹闭。流出系统的出血与中心静脉压（CVP）密切相关。降低 CVP 可减少出血；特别是，通过麻醉管理将 CVP 保持在 5cmH(2)O 以下是减少出血的一种简单有效的方法。尽管麻醉努力，在某些情况下 CVP 仍然较高，但在这些情况下，还有其他技术可用，包括肝下腔静脉夹闭和术中血液回收。
