Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Asian J Surg. 2013 Jul;36(3):111-5. doi: 10.1016/j.asjsur.2013.01.002. Epub 2013 Mar 16.
Massive hemorrhage and the need for blood transfusion carry a high rate of morbidity and mortality after hepatectomy. The aim of this study was to evaluate the safety and potential benefit of infrahepatic inferior vena cava (IVC) clamping in hepatectomy for tumors involving hepatocaval confluence.
We conducted a retrospective analysis of 113 consecutive patients who underwent hepatectomy with infrahepatic IVC clamping (n = 60, Group A) and without infrahepatic IVC clamping (n = 53, Group B) as the initial treatment for tumors involving hepatocaval confluence.
In Group A, central venous pressure reduced from 7.6 ± 3.2 to 4.4 ± 2.7 cm H₂O (p < 0.001). Patients in Group A experienced less blood loss (477.3 ± 340.3 vs. 794.5 ± 602.7 mL, p = 0.001), fewer blood transfusion requirements (8.3% vs. 22.6%, p = 0.034), lower postoperative complications (40% vs. 60.4%, p = 0.031), and shorter hospital stay (10.7 ± 2.2 vs. 12.9 ± 4.8 days, p = 0.008) than those in Group B.
Infrahepatic IVC clamping is generally effective and safe in controlling bleeding during hepatectomy for tumors involving hepatocaval confluence.
肝切除术后大量出血和输血需求会导致高发病率和死亡率。本研究旨在评估肝静脉汇合部肿瘤肝切除术中肝下下腔静脉（IVC）夹闭的安全性和潜在益处。
我们对 113 例连续接受肝下 IVC 夹闭肝切除术（n=60，A 组）和未行肝下 IVC 夹闭肝切除术（n=53，B 组）作为肝静脉汇合部肿瘤初始治疗的患者进行回顾性分析。
A 组患者中心静脉压从 7.6±3.2cmH₂O 降至 4.4±2.7cmH₂O（p<0.001）。A 组患者出血量较少（477.3±340.3 vs. 794.5±602.7mL，p=0.001），输血需求较少（8.3% vs. 22.6%，p=0.034），术后并发症发生率较低（40% vs. 60.4%，p=0.031），住院时间较短（10.7±2.2 vs. 12.9±4.8 天，p=0.008）。
肝静脉汇合部肿瘤肝切除术中肝下 IVC 夹闭通常是有效和安全的，可以控制出血。
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