Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
World J Surg. 2021 Sep;45(9):2911-2923. doi: 10.1007/s00268-021-06159-4. Epub 2021 May 28.
Infrahepatic inferior vena cava (IVC) clamping reduces central venous pressure. However, controversies remain regarding its impact on postoperative complications, particularly, the incidence of postoperative pulmonary embolism (PE). The aim of the study was to determine the impact of IVC clamping on the incidence of PE in patients undergoing hepatectomy.
A pooled analysis of five prospective trials on patients who underwent hepatic resection over a period of 10 years was performed. Patients with infrahepatic IVC clamping were compared to patients without infrahepatic IVC clamping. Outcomes were studied by univariate and multivariate analyses.
Of 505 included patients, 141 patients had IVC clamping and 364 patients served as control group. The rate of postoperative PE was comparable between groups (3% vs. 3%; P = 0.762), as were postoperative morbidity (P = 0.932), bile leakage (P = 0.272), posthepatectomy hemorrhage (P = 0.095), and posthepatectomy liver failure (P = 0.605), respectively. No clinicopathological and intraoperative risk factors were found to predict the onset of PE. Subgroup analyses of patients with major hepatectomy and vascular resections confirmed no adverse perioperative outcomes to be associated with IVC clamping.
Infrahepatic IVC clamping does not increase the incidence of postoperative PE.
肝下下腔静脉（IVC）夹闭可降低中心静脉压。然而，其对术后并发症，尤其是术后肺栓塞（PE）发生率的影响仍存在争议。本研究旨在确定肝切除术患者中 IVC 夹闭对 PE 发生率的影响。
对 10 年内进行肝切除术的 5 项前瞻性试验的患者进行汇总分析。将有肝下 IVC 夹闭的患者与无肝下 IVC 夹闭的患者进行比较。采用单因素和多因素分析研究结局。
505 例纳入患者中，141 例有 IVC 夹闭，364 例为对照组。两组术后 PE 发生率相当（3%比 3%；P=0.762），术后并发症（P=0.932）、胆漏（P=0.272）、肝切除术后出血（P=0.095）和肝切除术后肝功能衰竭（P=0.605）的发生率也相似。未发现临床病理和术中危险因素可预测 PE 的发生。主要肝切除术和血管切除术患者的亚组分析证实，IVC 夹闭与围手术期不良结局无关。
肝下 IVC 夹闭不会增加术后 PE 的发生率。
