Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Anesthesia and Operating Centre, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Surgery. 2022 Jun;171(6):1596-1604. doi: 10.1016/j.surg.2021.11.012. Epub 2021 Dec 13.
The feasibility and safety of using longer ischemic interval during intermittent Pringle maneuver for hepatectomy in patients with hepatocellular carcinoma are still unclear. The aim of this study was to compare the short-term outcomes of hepatectomy using intermittent Pringle maneuver with an ischemic interval of 25 minutes versus 15 minutes in hepatocellular carcinoma patients.
A total of 344 patients with hepatocellular carcinoma undergoing hepatectomy were randomized to receive the intermittent Pringle maneuver with a 15-minute (n = 172) or 25-minute (n = 172) ischemic interval. Primary endpoint was transaminase-based postoperative hepatic injury, assessed by their peak values as well as area under the curve of the postoperative course of aminotransferases. Secondary endpoints included the intraoperative blood loss, transection speed, morbidity, mortality, and postoperative inflammatory reaction.
There were no significant differences between the 2 groups in the postoperative aminotransferase serum levels or their area under the curve values, but the 25-minute intermittent Pringle maneuver group was associated with significantly higher speed for liver transection (1.38 vs 1.23 cm/min, P = .002) and a lower blood loss during transection (109 vs 166 mL, P < .001) than the 15-minute intermittent Pringle maneuver group. Postoperative complications, inflammatory cytokines serum levels, and 90-day mortality were comparable. Stratification analysis showed that the 25-minute intermittent Pringle maneuver did not aggravate the hepatic injury but resulted in a lower blood loss during transection and higher transection speed in hepatocellular carcinoma patient undergoing laparoscopic or open hepatectomy.
Intermittent Pringle maneuver with a 25-minute ischemic interval can be applied safely and efficiently in open or laparoscopic hepatectomy in patients with hepatocellular carcinoma patients.
在肝细胞癌患者中，间歇性阻断血流期间使用较长的缺血时间进行肝切除术的可行性和安全性仍不清楚。本研究旨在比较间歇性阻断血流 15 分钟与 25 分钟两种缺血时间在肝细胞癌患者肝切除术中的短期结果。
共有 344 例接受肝切除术的肝细胞癌患者被随机分为接受间歇性阻断血流 15 分钟（n=172）或 25 分钟（n=172）缺血时间的两组。主要终点是基于转氨酶的术后肝损伤，通过术后转氨酶的峰值和曲线下面积来评估。次要终点包括术中出血量、横断速度、发病率、死亡率和术后炎症反应。
两组间术后转氨酶血清水平或其曲线下面积值无显著差异，但 25 分钟间歇性阻断血流组的肝横断速度明显较快（1.38 比 1.23cm/min，P=0.002），横断期间出血量较低（109 比 166mL，P<0.001）。术后并发症、炎症细胞因子血清水平和 90 天死亡率相当。分层分析表明，25 分钟间歇性阻断血流不会加重肝损伤，但会降低腹腔镜或开腹肝切除术中肝细胞癌患者的横断期间出血量和提高横断速度。
在肝细胞癌患者的开腹或腹腔镜肝切除术中，间歇性阻断血流 25 分钟的缺血时间可以安全有效地应用。
