Lee Kit Fai, Wong John, Cheung Sunny Y S, Chong Charing C N, Hui Joyce W Y, Leung Vivian Y F, Yu Simon C H, Lai Paul B S
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, N.T., Hong Kong SAR, China.
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32, Ngan Shing Street, Shatin, N.T., Hong Kong SAR, China.
World J Surg. 2018 Oct;42(10):3302-3311. doi: 10.1007/s00268-018-4637-3.
In a previous study, we have shown that intermittent Pringle maneuver (IPM) might increase postoperative complications after hepatectomy for various indications. Complications which thought to be related to IPM were ascites, pleural effusion, wound infection and intra-abdominal collection. The aim of this study was to test the hypothesis that applying IPM during hepatectomy for hepatocellular carcinoma (HCC) could increase postoperative complications.
Between January 2013 and October 2016, eligible patients who received elective open hepatectomy for HCC were randomized to have IPM or no Pringle maneuver (NPM). Occurrence of various types of postoperative complications was specifically looked for. A routine postoperative day 5 abdominal ultrasound examination and chest X-ray were done to detect and grade any radiological ascites, pleural effusion and intra-abdominal collection.
Fifty IPM and 50 NPM patients with histological proven HCC were recruited for final analysis. Demographics and operative parameters were comparable between the two groups. The postoperative complication rates were similar (IPM 36.0 vs. NPM 28.0%, P = 0.391). However, in the IPM group, more patients developed radiological posthepatectomy ascites (42.0 vs. 22.0%, P = 0.032) and pleural effusion (66.0 vs. 38.0%, P = 0.005). In patients with histologically proven cirrhosis, there were 28 IPM and 25 NPM patients. Again, there was no difference in postoperative complication rate but more radiological posthepatectomy ascites and pleural effusion in the IPM group.
This trial was not able to detect a difference in postoperative complications whether IPM was applied or not, but use of IPM was associated with more subclinical ascites and pleural effusion. (ClinicalTrials.gov NCT01759901).
ClinicalTrials.gov NCT01759901.
在之前的一项研究中，我们已经表明，间歇性肝门阻断（IPM）可能会增加因各种适应证行肝切除术后的并发症。被认为与IPM相关的并发症有腹水、胸腔积液、伤口感染和腹腔内积液。本研究的目的是检验这样一个假设，即在肝细胞癌（HCC）肝切除术中应用IPM会增加术后并发症。
在2013年1月至2016年10月期间，将接受择期开放性HCC肝切除术的符合条件的患者随机分为接受IPM组或不进行肝门阻断（NPM）组。特别关注各种类型术后并发症的发生情况。术后第5天常规进行腹部超声检查和胸部X线检查，以检测并分级任何影像学上的腹水、胸腔积液和腹腔内积液。
招募了50例接受IPM的患者和50例接受NPM的经组织学证实为HCC的患者进行最终分析。两组患者的人口统计学和手术参数具有可比性。术后并发症发生率相似（IPM组为36.0%，NPM组为28.0%，P = 0.391）。然而，在IPM组中，更多患者出现了肝切除术后影像学腹水（42.0%对22.0%，P = 0.032）和胸腔积液（66.0%对38.0%，P = 0.005）。在经组织学证实为肝硬化的患者中，有28例接受IPM的患者和25例接受NPM的患者。同样，术后并发症发生率没有差异，但IPM组有更多的肝切除术后影像学腹水和胸腔积液。
本试验未能检测出应用IPM与否在术后并发症方面的差异，但应用IPM与更多的亚临床腹水和胸腔积液相关。（ClinicalTrials.gov NCT01759901）。
ClinicalTrials.gov NCT01759901。
