Ninh Khai Viet, Nguyen Nghia Quang, Trinh Son Hong, Pham Anh Gia, Doan Thi-Ngoc-Ha
Viet Duc University Hospital, Hanoi, Vietnam.
Hanoi Medical University, Hanoi, Vietnam.
Int J Hepatol. 2021 Apr 28;2021:6648663. doi: 10.1155/2021/6648663. eCollection 2021.
Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result).
In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications.
We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in 52.6 ± 33 months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm) to body weight (kg) > 0.8% (for right hepatectomy). Perioperative parameters were collected and analyzed.
The average operation time was 196.2 ± 62.2 minutes, and blood loss was 261.4 ± 202.9 ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was 11.4 ± 3.7 days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%.
SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.
肝切除术一直是外科医生面临的一项挑战，需要针对特定肿瘤采取合适的方法以实现有效的并发症管理。与全肝蒂阻断相比，选择性肝蒂阻断在减少失血和输血与避免肝实质损伤（影响肝切除结果的两个主要并发症）之间的平衡方面是更值得考虑的策略。
在本研究中，我们旨在描述选择性肝血流血管阻断（SHIVO）和解剖性前入路在肝切除术中的应用，并评估结果，重点关注术中及术后并发症。
我们纳入了72例在越南德和医院在4年期间（2011 - 2014年）接受SHIVO肝切除术的患者，然后对他们全部进行随访直至2020年6月（随访时间为52.6±33个月；范围为2 - 105个月）或直至死亡。所有患者均被诊断为原发性或继发性肝癌，且其在64层CT扫描上测量的未来残余肝体积（dm）与体重（kg）之比>0.8%（适用于右半肝切除术）。收集并分析围手术期参数。
平均手术时间为196.2±62.2分钟，失血量为261.4±202.9毫升；手术期间及术后的总输血比例为16.7%。并发症发生率为44.5%的患者，其中胸腔积液是最常见的（41.7%）。术后无肝衰竭和胆瘘发生。术后30天内无死亡记录。平均住院时间为11.4±3.7天。在我们的研究中，术中输血和大肝切除术是显著影响肝切除术后并发症发生率的因素。在最后一次随访评估中，44例患者死亡，28例患者存活，其中7例复发，21例未复发。总生存率为38.9%。
解剖性肝切除术中的SHIVO是一种安全可行的方法，有助于精确切除靶向肿瘤并处理肝切除术中的多种并发症。
