Gao Zhenzhen, Li Zhiwei, Zhou Bo, Chen Lifeng, Shen Zhenhua, Jiang Yuancong, Zheng Xiang, Xiang Jie, Zhang Qiyi, Wang Weilin, Yan Sheng
Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Minim Access Surg. 2021 Jan-Mar;17(1):120-126. doi: 10.4103/jmas.JMAS_130_19.
Laparoscopic liver resection (LLR) allows minimal incisions and relatively quicker post-operative recovery, while intraoperative massive haemorrhage led to conversion to laparotomy. This study aimed to introduce a new, safe and convenient device to serve as Pringle's manoeuver according to the demand in LLR.
A liver circle consisting of a hole and a round stem with an obtuse small head was made by medical silica gel. It was applied in LLR to perform on-demand Pringle's manoeuver and developed its function in inferior vena cava (IVC) occlusion. The time of performing Pringle's manoeuver by liver circle, extracorporeal tourniquet and endo intestinal clip under laparoscopic simulator and LLR was compared.
The liver circle was successfully applied to perform Pringle's manoeuver, IVC exposure and occlusion. It took less time in the occluding step of Pringle's manoeuver than the extracorporeal tourniquet (4.15 ± 0.35 s vs. 9.90 ± 1.15 s, P < 0.05) and the endo intestinal clip (4.15 ± 0.35 s vs. 47.91 ± 3.98 s, P < 0.05) under LLR. The total manipulating time for Pringle's manoeuver with liver circle remained the shortest, and the advantages were more obvious with increased frequencies of intermittent Pringle's manoeuver.
The new-designed liver circle is more convenient compared to other techniques in performing Pringle's manoeuver, especially the intermittent Pringle's manoeuver in LLR. It can be used to perform on-demand hepatic blood inflow occlusion in every LLR by pre-circling the hepatoduodenal ligament to control bleeding during surgery. It can also be applied to expose the surgical field of vision and perform IVC occlusion to reduce intraoperative blood loss.
腹腔镜肝切除术（LLR）切口小，术后恢复相对较快，但术中大出血会导致中转开腹。本研究旨在根据LLR的需求引入一种新的、安全便捷的装置来实施Pringle手法。
用医用硅胶制作一个带有孔和圆形柄且头部为钝角小凸起的肝圈。将其应用于LLR以按需实施Pringle手法，并开发其在下腔静脉（IVC）阻断方面的功能。比较在腹腔镜模拟器和LLR下使用肝圈、体外止血带和内镜肠夹实施Pringle手法的时间。
肝圈成功用于实施Pringle手法、暴露和阻断IVC。在LLR下，肝圈在Pringle手法阻断步骤中花费的时间比体外止血带少（4.15±0.35秒对9.90±1.15秒，P<0.05），也比内镜肠夹少（4.15±0.35秒对47.91±3.98秒，P<0.05）。使用肝圈进行Pringle手法的总操作时间仍然最短，且随着间歇性Pringle手法频率增加，优势更明显。
新设计的肝圈在实施Pringle手法方面比其他技术更便捷，尤其是在LLR中的间歇性Pringle手法。它可通过预先环绕肝十二指肠韧带用于在每次LLR中按需阻断肝血流以控制术中出血。还可用于暴露手术视野并实施IVC阻断以减少术中失血。
