Feng Li, Wang Liming, Rong Weiqi, Wu Fan, Yu Weibo, An Songlin, Liu Faqiang, Tian Fei, Wu Jianxiong
Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
Department of Abdominal Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China; Email:
Zhonghua Zhong Liu Za Zhi. 2015 Mar;37(3):186-9.
To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC).
A total of 54 patients with HCC who underwent hepatectomy were divided into two groups: RIP group (regional ischemic preconditioning with continuous clamping, n=15) and HHV group (hemi-hepatic vascular inflow occlusion, n=39). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared.
The volume of intraoperative blood loss had significant difference between the two groups (P=0.039). One case (6.7%) in the RIP group and 17 cases (43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time (P>0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P>0.05) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006).
The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.
初步评估两种肝血流阻断方式在肝细胞癌（HCC）肝切除术中的临床疗效。
将54例行肝切除术的HCC患者分为两组：RIP组（持续夹闭区域缺血预处理，n = 15）和HHV组（半肝血流阻断，n = 39）。HHV组通过夹闭肝右动脉和肝右门静脉进行，直至肝切除完成。在RIP组中，HHV之前先进行5分钟的缺血，然后再灌注5分钟。比较两组的临床指标。
两组术中出血量有显著差异（P = 0.039）。RIP组有1例（6.7%）、HHV组有17例（43.6%）接受了术后输血，差异有统计学意义（P = 0.010）。所有患者术后30天均无死亡。两组在住院时间或术后并发症方面无显著差异，包括肝功能不全、感染、腹水、胸腔积液、心肺并发症和肠道通气时间（均P > 0.05）。RIP组术后第3天和第5天的凝血酶原活动度（PTA）水平显著更高（P < 0.001）。虽然两组在术后任何阶段的总胆红素、白蛋白、前白蛋白和转氨酶方面均无显著差异（P > 0.05），但RIP组有5例（33.3%）谷丙转氨酶（ALT）恢复至正常水平，而HHV组仅1例（2.7%），两组差异有统计学意义（P = 0.006）。
本研究结果表明，区域缺血预处理在肝切除术中可能比半肝血流阻断具有更好的止血效果，能减少术后输血并促进肝功能早期恢复。
