Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Department of laboratory, Fujia Medical University Union Hospital, Fuzhou, Fujian, China.
Int J Surg. 2020 Sep;81:158-164. doi: 10.1016/j.ijsu.2020.06.034. Epub 2020 Jul 3.
The intermittent Pringle's maneuver (IPM) is conducted mainly during the procedure of hepatectomy to control intraoperative blood loss (IBL), but it has been questioned since improvement of surgical technology and intraoperative management. Hence, we conducted a systematic review and meta-analysis to validate the clinical value of IPM.
Eligible studies that were designed to evaluate the IPM in the procedure of hepatectomy were searched for on PubMed, Medline, and other databases from establishment of the database to October 2019. The primary endpoints were IBL and intraoperative blood transfusion (IBT). The risk ratio (RR) with 95% confidence interval (CI) was used to determine the effect size.
A total of 16 studies with six randomized controlled trials (RCTs) were enrolled in this meta-analysis, including 1,770 cases in the IPM group and 1,611 cases in the non-IPM group. Overall, there were no significant differences between the IPM and non-IPM groups in the amount of IBL and the incidence of IBT (RR = 0.96, 95% CI 0.67-1.37, P = 0.82), which was also confirmed in the subgroups of RCTs (P > 0.05). However, subgroup analyses showed that for patients with colorectal liver metastasis (CRLM), the amount of IBL was generally higher in the IPM group than in the non-IPM group, and the incidence of IBT was significantly higher in the IPM group (RR = 7.17, 95% CI 1.91-26.94, P = 0.004). In addition, no significant differences were observed in terms of postoperative complications between the two groups (all P > 0.05).
With the current data, we concluded that IPM had lost its value in patients with CRLM, although it remained controversial in patients with hepatocellular carcinoma.
间歇式阻断肝门血流（IPM）主要用于肝切除术以控制术中失血量（IBL），但随着手术技术和术中管理的改进，其作用受到质疑。因此，我们进行了系统评价和荟萃分析，以验证 IPM 的临床价值。
检索 PubMed、Medline 和其他数据库自数据库建立至 2019 年 10 月期间发表的评估肝切除术期间 IPM 的研究。主要终点是 IBL 和术中输血（IBT）。使用风险比（RR）及其 95%置信区间（CI）来确定效应量。
本荟萃分析共纳入 16 项研究，其中包括 6 项随机对照试验（RCT），共 1770 例患者接受 IPM 组，1611 例患者接受非 IPM 组。总体而言，IPM 组与非 IPM 组在 IBL 量和 IBT 发生率方面无显著差异（RR=0.96，95%CI 0.67-1.37，P=0.82），RCT 亚组分析也证实了这一点（P>0.05）。然而，亚组分析显示，对于结直肠癌肝转移（CRLM）患者，IPM 组的 IBL 量普遍高于非 IPM 组，而 IPM 组的 IBT 发生率明显更高（RR=7.17，95%CI 1.91-26.94，P=0.004）。此外，两组术后并发症发生率无显著差异（均 P>0.05）。
根据现有数据，我们得出结论，IPM 在 CRLM 患者中已失去价值，尽管在肝细胞癌患者中仍存在争议。
