阻断肝门血流操作（Pringle maneuver）何时会造成伤害？

When does a Pringle Maneuver cause harm?

机构信息

Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA 19140, USA.

Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.

出版信息

HPB (Oxford). 2021 Apr;23(4):587-594. doi: 10.1016/j.hpb.2020.07.014. Epub 2020 Sep 12.

DOI:10.1016/j.hpb.2020.07.014

PMID:32933844

Abstract

BACKGROUND

The Pringle Maneuver (PM) is considered to be safe and effective. However, data regarding perioperative outcomes after a PM are conflicting. Therefore, the aim of this analysis is to compare the outcomes of patients who have and have not undergone a PM in North America.

METHODS

Patients undergoing major (≥3 segments) or partial hepatectomy (≤2 segments) were identified in the 2014-17 ACS-NSQIP hepatectomy database. Patients with and without a PM were compared. Propensity matching was utilized, and subgroup analyses by liver texture, hepatectomy extent and pathology were performed.

RESULTS

Prior to matching, 3706 (24%) of 15,748 hepatectomy patients underwent a PM. The PM was utilized in 1445 (27%) of major and 2261 (22%) of partial hepatectomies. After matching, 3295 patients with and 3295 without a PM were compared. Operative time was significantly increased for patients undergoing a PM (246 vs. 225 min, p < 0.001). Subgroup analyses revealed post-hepatectomy liver failure and septic shock to be significantly increased (both p < 0.05) for patients undergoing a PM during a partial hepatectomy or in patients with metastatic disease.

CONCLUSION

Patients undergoing a partial hepatectomy and those with metastatic disease have worse outcomes when a Pringle Maneuver is performed.

摘要

背景

Pringle 手法（PM）被认为是安全有效的。然而，关于 PM 后围手术期结果的数据存在争议。因此，本分析旨在比较北美接受和未接受 PM 的患者的结局。

方法

在 2014-17 年 ACS-NSQIP 肝切除术数据库中确定接受大（≥3 段）或部分肝切除术（≤2 段）的患者。比较接受和未接受 PM 的患者。采用倾向匹配，并按肝质地、肝切除术范围和病理进行亚组分析。

结果

在匹配前，15748 例肝切除患者中有 3706 例（24%）接受了 PM。PM 在 1445 例大肝切除（27%）和 2261 例部分肝切除（22%）中使用。匹配后，比较了 3295 例接受和 3295 例未接受 PM 的患者。接受 PM 的患者手术时间明显延长（246 分钟比 225 分钟，p<0.001）。亚组分析显示，接受部分肝切除术或转移性疾病的患者行 PM 后肝衰竭和感染性休克的发生率显著增加（均 p<0.05）。