Dou Lei, Yu Zong-Ping, Yang Hui-Yuan, Ran Ji, Chen Yi-Fa, Chen Xiao-Ping
Department of Surgery, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.
Department of Gerontology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.
ANZ J Surg. 2018 Jul-Aug;88(7-8):E606-E609. doi: 10.1111/ans.14301. Epub 2017 Dec 10.
This study introduces an innovative stepwise vascular control technique to address the high risk of massive bleeding from main hepatic veins and the retro-hepatic inferior vena cava during hepatectomy involving hepatocaval confluence.
From January 2010 to July 2016, 80 patients underwent stepwise vascular occlusion during complex liver resection involving hepatocaval confluence. Relevant clinical data were collected and compared with those obtained in parallel studies. The protocol has been registered in the Protocol Registration and Results System as protocol NCT02996006.
All 80 patients underwent portal triad (PT), infra-hepatic inferior vena cava (IIVC) and supra-hepatic inferior vena cava (SIVC) preparation for occlusion in that order; PT, PT + SIVC and PT + IIVC + SIVC occlusions were performed during liver resection for six, 42 and 32 patients, respectively. The PT, IIVC and SIVC clamping times were 12.9 ± 2.5, 9.1 ± 2.1 and 5.1 ± 1.4 min, respectively. The mean blood loss was 504.1 ± 234.5 mL. Sixteen patients received blood transfusions. Haemodynamic parameters remained stable. No patients had life-threatening complications or died (Clavien-Dindo grade IV or V). Compared with other techniques used in parallel studies, this technique has the advantage of decreased blood loss in less warm ischaemia time.
For complex hepatectomy involving hepatocaval confluence, this newly described stepwise vascular control technique was efficacious and feasible for controlling intraoperative bleeding.
本研究引入了一种创新的逐步血管控制技术，以应对在涉及肝腔静脉汇合处的肝切除术中，主肝静脉和肝后下腔静脉大出血的高风险。
2010年1月至2016年7月，80例患者在涉及肝腔静脉汇合处的复杂肝切除术中接受了逐步血管阻断。收集相关临床数据，并与同期研究中获得的数据进行比较。该方案已在方案注册和结果系统中注册，注册号为NCT02996006。
所有80例患者均依次进行了门静脉三联（PT）、肝下下腔静脉（IIVC）和肝上下腔静脉（SIVC）的阻断准备；在肝切除术中，分别对6例、42例和32例患者进行了PT、PT + SIVC和PT + IIVC + SIVC阻断。PT、IIVC和SIVC的阻断时间分别为12.9±2.5、9.1±2.1和5.1±1.4分钟。平均失血量为504.1±234.5毫升。16例患者接受了输血。血流动力学参数保持稳定。没有患者出现危及生命的并发症或死亡（Clavien-Dindo分级为IV级或V级）。与同期研究中使用的其他技术相比，该技术具有在较短热缺血时间内减少失血量的优势。
对于涉及肝腔静脉汇合处的复杂肝切除术，这种新描述的逐步血管控制技术在控制术中出血方面是有效且可行的。
