Wang Li-ming, Wu Fan, Wu Jian-xiong, Liu Li-guo, Rong Wei-qi, Miao Cheng-li, Zhong Yu-xin, Wang Yi-peng
Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2012 Jan 31;92(4):259-63.
To retrospectively explore the clinical efficacies and applicability of anatomical vascular occlusion (AVO) in hepatectomy for grand primary hepatocarcinoma at different locations.
A total of 212 grand primary hepatocarcinoma cases undergoing hepatectomy were divided into 2 groups by vascular occlusion in the process of resection: AVO group (n = 97) and Pringle group (Pringle maneuver, n = 115). According to whether or not tumor was adjacent to main vessels, the cases were divided into 2 types: centrally (n = 98) and peripherally (n = 114) located lesions. And the perioperative outcomes were compared between 2 groups totally and by types respectively.
No significance existed between the AVO and Pringle groups in the demographic characteristics and tumor background (P > 0.05). For total cases, there were no significant differences between 2 groups regarding the intraoperative blood loss volume ((632 ± 437) ml vs (546 ± 549) ml, P = 0.217) and the blood transfusion requirement (44.3% vs 33.0%, P = 0.092). The AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase (P > 0.05). But no significant difference was found between 2 groups in the postoperative complication rate (18.6% vs 22.6%, P = 0.469) and hospital stay duration ((10.5 ± 4.8) vs (11.8 ± 5.6) days, P = 0.087). In centrally located lesions: the AVO group showed a significantly smaller intraoperative blood loss volume ((722 ± 492) ml vs (1032 ± 618) ml, P = 0.007) and blood transfusion requirement (45.6% vs 68.3%, P = 0.026). Also the AVO group showed significantly better postoperative liver functions in terms of serum levels of total bilirubin and aminotransferase (P < 0.01). As a consequence, the AVO group had a significantly lower postoperative complication rate (19.3% vs 39.0%, P = 0.031) and a shorter hospital stay duration ((10.7 ± 5.0) days vs (13.0 ± 6.2) days, P = 0.042). In peripheral located lesions: there were significantly larger intraoperative blood loss volume (504 ± 307 vs 278 ± 237 ml, P = 0.000) and blood transfusion requirement (42.5% vs 13.5%, P = 0.001) in the AVO group. The postoperative liver functions (total bilirubin and aminotransferase levels, P > 0.05), postoperative complication rate (17.5% vs 13.5%, P = 0.808) and hospital stay duration ((10.3 ± 4.6) days vs (11.1 ± 5.1) days, P = 0.429) showed no significant differences between 2 groups.
The technique of AVO is unsuitable for all types of grand hepatocarcinoma. Whether or not the tumor is adjacent to main vessels is an important consideration of choosing the vascular control technique. Considering the risk of vascular damage in the process of hepatectomy, the AVO technique is indicated for the resection of central lesions but not for peripheral lesions.
回顾性探讨解剖性血管阻断（AVO）在不同部位巨大原发性肝癌肝切除术中的临床疗效及适用性。
将212例行肝切除术的巨大原发性肝癌患者在切除过程中根据血管阻断方式分为2组：AVO组（n = 97）和Pringle组（Pringle手法，n = 115）。根据肿瘤是否邻近主要血管，将病例分为2型：中央型（n = 98）和外周型（n = 114）。分别对两组总体及各型的围手术期结果进行比较。
AVO组和Pringle组在人口统计学特征和肿瘤背景方面无显著差异（P > 0.05）。对于总体病例，两组在术中失血量（（632 ± 437）ml对（546 ± 549）ml，P = 0.217）和输血需求（44.3%对33.0%，P = 0.092）方面无显著差异。AVO组在血清总胆红素和转氨酶水平方面术后肝功能明显更好（P > 0.05）。但两组在术后并发症发生率（18.6%对22.6%，P = 0.469）和住院时间（（10.5 ± 4.8）天对（11.8 ± 5.6）天，P = 0.087）方面无显著差异。在中央型病变中：AVO组术中失血量明显更少（（722 ± 492）ml对（1032 ± 618）ml，P = 0.007），输血需求也更少（45.6%对68.3%，P = 0.026）。AVO组在血清总胆红素和转氨酶水平方面术后肝功能也明显更好（P < 0.01）。因此，AVO组术后并发症发生率明显更低（19.3%对39.0%，P = 0.031），住院时间更短（（10.7 ± 5.0）天对（13.0 ± 6.2）天，P = 0.042）。在外周型病变中：AVO组术中失血量（504 ± 307对278 ± 237 ml，P = 0.000）和输血需求（42.5%对13.5%，P = 0.001）明显更多。两组在术后肝功能（总胆红素和转氨酶水平，P > 0.05）、术后并发症发生率（17.5%对13.5%，P = 0.808）和住院时间（（10.3 ± 4.6）天对（11.1 ± 5.1）天，P = 0.429）方面无显著差异。
AVO技术不适用于所有类型的巨大肝癌。肿瘤是否邻近主要血管是选择血管控制技术的重要考虑因素。考虑到肝切除过程中血管损伤的风险，AVO技术适用于中央型病变的切除，而不适用于外周型病变。
