The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Int J Surg. 2014;12(8):768-73. doi: 10.1016/j.ijsu.2014.05.068. Epub 2014 Jun 5.
To compare the efficacy of selective hepatic vascular exclusion versus Pringle manoeuvre in partial hepatectomy for tumours adjacent to the hepatocaval junction.
A randomized comparative trial was carried out. The primary endpoint was intraoperative blood loss. The secondary endpoints were operation time, blood transfusion, postoperative liver function recovery, procedure-related morbidity and in-hospital mortality.
160 patients were randomized into 2 groups: the Pringle manoeuvre group (n = 80) and the selective hepatic vascular exclusion (SHVE) group (n = 80). Intraoperative blood loss and transfusion requirements were significantly less in the SHVE group. In the SHVE group, laceration of hepatic veins happened in 18 patients. Profuse intraoperative blood loss of over 2 L happened in 2 patients but no patient suffered from air embolism because the hepatic veins were controlled. In the Pringle group, the hepatic veins were lacerated in 20 patients, with profuse blood loss of over 2 L in 7 patients and air embolism in 3 patients. The rates of postoperative bleeding, reoperation, liver failure and mortality were significantly higher and the ICU stay and hospital stay were significantly longer in the Pringle group.
SHVE was more efficacious than Pringle manoeuvre for partial hepatectomy in patients with tumours adjacent to the hepatocaval junction.
比较选择性肝血管阻断与肝门阻断在肝门附近肿瘤行半肝切除术中的疗效。
进行了一项随机对照试验。主要终点是术中出血量。次要终点包括手术时间、输血、术后肝功能恢复、与手术相关的发病率和住院死亡率。
160 例患者随机分为 2 组：肝门阻断组（n = 80）和选择性肝血管阻断组（SHVE）（n = 80）。SHVE 组术中出血量和输血需求明显减少。在 SHVE 组，18 例患者肝静脉撕裂。2 例患者发生超过 2 L 的大量术中出血，但由于控制了肝静脉，没有患者发生空气栓塞。在肝门阻断组，20 例患者肝静脉撕裂，7 例患者出血量超过 2 L，3 例患者发生空气栓塞。术后出血、再次手术、肝功能衰竭和死亡率的发生率明显较高，肝门阻断组的 ICU 住院时间和住院时间明显较长。
对于肝门附近肿瘤行半肝切除术，SHVE 比肝门阻断更有效。
