Sui Cheng-jun, Lu Jiong-jiong, Xu Feng, Shen Wei-feng, Geng Li, Xie Feng, Dai Bing-hua, Yang Jia-mei
Department of Special Medical Care I and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Zhonghua Wai Ke Za Zhi. 2013 Apr;51(4):331-4.
To study the clinical value of total hemihepatic vascular exclusion (THHVE) in liver resection for patients with hepatocellular carcinoma (HCC) and impaired liver function.
The data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively. THHVE was applied in 38 patients (THHVE group), Pringle maneuver in 25 patients (Pringle group) and no vascular occlusion in 7 patients. In the THHVE group, 36 patients were male, 2 were female, average age was (54 ± 9) years. And in Pringle group, 23 patients were male, 2 were female, average age was (53 ± 10) years. Total intraoperative blood loss, blood transfusion rate, clamping time, postoperative complication rate, postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group.
Total blood loss ((317 ± 186) ml vs. (506 ± 274) ml, t = -3.025, P = 0.004) and transfusion rate (10.5% vs. 32.0%, χ(2) = 4.509, P = 0.034) were significantly lower in the THHVE group than in the Pringle group. Although the clamping time was longer ((21 ± 5) minutes vs. (17 ± 5) minutes, t = 3.209, P = 0.002), the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1, 3, 7 were significantly lower in the THHVE group than in the Pringle group, and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group. Total complication rate (26.3% vs. 52.0%, χ(2) = 4.291, P = 0.038) and major complication rate (7.9% vs. 28.0%, χ(2) = 4.565, P = 0.033) were lower in the THHVE group than in the Pringle group. And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group ((14.0 ± 2.6) d vs. (16.4 ± 4.0) d, t = -2.625, P = 0.012).
THHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function. It is associated with less blood loss, lower transfusion requirements, better postoperative liver function recovery, lower postoperative complication rate and shorter postoperative hospital stay.
探讨全肝血流阻断（THHVE）在肝功能受损的肝细胞癌（HCC）患者肝切除术中的临床价值。
回顾性分析2009年1月至2011年10月间70例行肝功能受损的HCC肝切除术患者的数据。38例患者采用THHVE（THHVE组），25例患者采用Pringle手法（Pringle组），7例患者未行血管阻断。THHVE组中，男性36例，女性2例，平均年龄（54±9）岁。Pringle组中，男性23例，女性2例，平均年龄（53±10）岁。比较THHVE组和Pringle组的术中总失血量、输血率、阻断时间、术后并发症发生率、术后住院时间及术后肝功能。
THHVE组的总失血量（（317±186）ml比（506±274）ml，t=-3.025，P=0.004）和输血率（10.5%比32.0%，χ²=4.509，P=0.034）显著低于Pringle组。虽然THHVE组的阻断时间较长（（21±5）分钟比（17±5）分钟，t=3.209，P=0.002），但THHVE组术后第3天和第7天的总胆红素水平以及术后第1天、3天、7天的ALT水平显著低于Pringle组，且THHVE组术后第7天的前白蛋白水平高于Pringle组。THHVE组的总并发症发生率（26.3%比52.0%，χ²=4.291，P=0.038）和主要并发症发生率（7.9%比28.0%，χ²=4.565，P=0.033）低于Pringle组。THHVE组的术后住院时间也短于Pringle组（（14.0±2.6）天比（16.4±4.0）天，t=-2.625，P=0.012）。
THHVE是肝功能受损的HCC患者肝切除术中一种安全有效的技术。它与较少的失血量、较低的输血需求、更好的术后肝功能恢复、较低的术后并发症发生率及较短的术后住院时间相关。
