Inoue Yoshihiro, Suzuki Yusuke, Fujii Kensuke, Kawaguchi Nao, Ishii Masatsugu, Masubuchi Shinsuke, Yamamoto Masashi, Hirokawa Fumitoshi, Hayashi Michihiro, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital , Takatsuki City, Japan .
J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):452-458. doi: 10.1089/lap.2017.0196. Epub 2017 Nov 3.
Laparoscopic hepatic resection (LHR) has been developed as a novel minimally invasive surgery. However, despite improvements in equipment and procedures, intraoperative hemorrhage remains an issue that requires great precaution. To reduce the amount of intraoperative blood loss, we perform the Pringle maneuver, aimed at occluding the inflow of blood into the liver during LHR. This article describes our experience performing LHR using the Pringle maneuver, including postoperative results, and discusses the safety and effectiveness of the Pringle maneuver.
Data from 83 patients who underwent laparoscopic partial right hepatic resection with or without the Pringle maneuver were retrospectively analyzed with respect to surgical outcomes, safety, and utility.
In LHR, the amount of bleeding was significantly lower in cases that included the Pringle maneuver (P = .0314). However, there were no differences in the duration of surgery, surgical margin, rate of curative resections, and incidence of postoperative complications. Laboratory data collected after surgery showed no significant difference between the two groups regardless of whether blood flow was occluded or not.
The Pringle maneuver may be effective in reducing the amount of intraoperative blood loss during laparoscopic partial right hepatic resection, although the difference is not clinically significant. Rather, the reduction in bleeding can reduce the stress experienced by the operator while keeping the transection stump of the liver dry. Particularly, the extracorporeal Pringle maneuver using cotton tape is simple and convenient and can be carried out within a short amount of time.
腹腔镜肝切除术（LHR）已发展成为一种新型微创手术。然而，尽管设备和手术方法有所改进，但术中出血仍是一个需要高度谨慎对待的问题。为减少术中失血量，我们在LHR过程中采用Pringle手法，旨在阻断流入肝脏的血流。本文介绍了我们使用Pringle手法进行LHR的经验，包括术后结果，并讨论了Pringle手法的安全性和有效性。
回顾性分析83例行腹腔镜右半肝切除术（无论是否采用Pringle手法）患者的手术结果、安全性和实用性数据。
在LHR中，采用Pringle手法的病例出血量显著更低（P = 0.0314）。然而，手术时间、手术切缘、根治性切除率和术后并发症发生率并无差异。术后收集的实验室数据显示，无论血流是否阻断，两组之间均无显著差异。
Pringle手法可能有效减少腹腔镜右半肝切除术中的术中失血量，尽管差异在临床上并不显著。相反，出血的减少可以减轻术者的压力，同时保持肝断面干燥。特别是，使用棉带的体外Pringle手法简单方便，可在短时间内完成。
