肝下下腔静脉阻断可减少胆管癌肝切除术中的失血。
Infrahepatic Inferior Vena Cava Clamping Reduces Blood Loss during Liver Transection for Cholangiocarcinoma.
作者信息
Leeratanakachorn Natwutpong, Luvira Vor, Tipwaratorn Theerawee, Theeragul Suapa, Jarearnrat Apiwat, Titapun Attapol, Srisuk Tharatip, Kamsa-Ard Supot, Pugkhem Ake, Khuntikeo Narong, Pairojkul Chawalit, Bhudhisawasdi Vajarabhongsa
机构信息
Department of Surgery, Faculty of Medicine, Khon Kaen University, 123 Mittraparp Road, Meaung District, Khon Kaen 40002, Thailand.
Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, 123 Mittraparp Road, Meaung District, Khon Kaen 40002, Thailand.
出版信息
Int J Hepatol. 2021 Aug 26;2021:1625717. doi: 10.1155/2021/1625717. eCollection 2021.
BACKGROUND
Major hepatectomy is the mainstay of the treatment for cholangiocarcinoma. Infrahepatic inferior vena cava (IVC) clamping is an effective maneuver for reducing blood loss during liver transection. The impact of this procedure on major hepatectomy for cholangiocarcinoma is unknown. This study evaluated the effect of infrahepatic IVC clamping on blood loss during liver transection.
METHODS
Clinical and pathological data were collected retrospectively for 116 cholangiocarcinoma patients who underwent major hepatectomy between January 2015 and December 2016, to investigate the benefit of infrahepatic IVC clamping. Two of five surgeons adapted the policy performing infrahepatic IVC clamping during liver transection in all cases. Patients, therefore, were divided into those ( = 39; 33.6%) who received infrahepatic IVC clamping during liver transection (C1) and those ( = 77; 66.4%) who did not (C0).
RESULTS
The patients' backgrounds, operative parameters, and extent of hepatectomy did not differ significantly between the 2 groups, except for gender. A significantly lower blood loss ( = 0.028), blood transfusion ( = 0.011), and rate of vascular inflow occlusion requirement ( < 0.001) were observed in the C1 group. The respective blood losses in the C1 group and the C0 group were 498.9 (95% CI: 375.8-622.1) and 685.6 (95% CI: 571-800.2) millilitres.
CONCLUSIONS
The current study found infrahepatic IVC clamping during liver transection for cholangiocarcinoma reduces blood loss, blood transfusion, and rate of vascular inflow occlusion requirement.
背景
肝大部切除术是胆管癌治疗的主要手段。肝下下腔静脉（IVC）阻断是减少肝切除术中失血的有效措施。该操作对胆管癌肝大部切除术的影响尚不清楚。本研究评估了肝下IVC阻断对肝切除术中失血的影响。
方法
回顾性收集2015年1月至2016年12月期间接受肝大部切除术的116例胆管癌患者的临床和病理数据，以研究肝下IVC阻断的益处。五名外科医生中有两名在所有病例的肝切除术中都采用了肝下IVC阻断策略。因此，患者被分为肝切除术中接受肝下IVC阻断的患者（n = 39；33.6%）和未接受的患者（n = 77；66.4%）。
结果
除性别外，两组患者的背景、手术参数和肝切除范围无显著差异。C1组的失血量（P = 0.028）、输血率（P = 0.011）和血管流入阻断需求率（P < 0.001）显著更低。C1组和C0组的失血量分别为498.9（95%CI：375.8 - 622.1）毫升和685.6（95%CI：571 - 800.2）毫升。
结论
本研究发现，胆管癌肝切除术中进行肝下IVC阻断可减少失血量、输血量和血管流入阻断需求率。
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