Inoue Yoshihiro, Suzuki Yusuke, Ota Masato, Kitada Kazuya, Kuramoto Toru, Matsuo Kentaro, Fujii Kensuke, Miyaoka Yuta, Kimura Fumiharu, Uchiyama Kazuhisa
Osaka Medical College Mishima-Minami Hospital, Osaka, Japan.
Osaka Medical College Hospital, Osaka, Japan.
Prz Gastroenterol. 2022;17(2):130-137. doi: 10.5114/pg.2021.110021. Epub 2021 Oct 13.
The Pringle manoeuvre is used in most hospitals to counteract intraoperative haemorrhage in laparoscopic hepatectomy by occluding the flow of blood to the liver. However, in laparoscopic repeat hepatectomy (LRH), outcomes of previous surgery and the influence of other factors frequently make it difficult to occlude the inflow of blood.
To discuss the value of inflow occlusion during LRH and provide tips for its performance.
Sixty-three patients who underwent LRH with or without the Pringle manoeuvre were analysed retrospectively. We investigated the efficacy and safety of the Pringle manoeuvre in LRH. Student's and χ tests, Mann-Whitney's test, Wilcoxon's signed-rank test, and Fisher's exact test were used in the statistical analysis.
Nineteen patients underwent LRH with the Pringle manoeuvre, and 44 patients underwent LHR without the Pringle manoeuvre. After propensity score matching, there were no significant differences in terms of operative time, estimated blood loss, and postoperative complication rate ( = 0.973, 0.120, and not applicable, respectively). However, the rate of conversion to open repeat hepatectomy (ORH) was significantly lower in the Pringle manoeuvre group ( = 0.034). In many cases, the cause of conversion to ORH was the non-use of inflow occlusion and the resulting inability to control intraoperative haemorrhage. Laboratory data collected after surgery showed no significant difference between the 2 groups regardless of whether blood flow was occluded or not.
LRH with the Pringle manoeuvre can be performed safely using various surgical devices. However, it is often challenging to perform the Pringle manoeuvre in patients with a history of cholecystectomy or segment 5 resection of the liver, and caution is required.
大多数医院在腹腔镜肝切除术中采用普林格尔手法，通过阻断肝脏血流来控制术中出血。然而，在腹腔镜再次肝切除术（LRH）中，既往手术的结果及其他因素的影响常常使得难以阻断入肝血流。
探讨LRH中入肝血流阻断的价值，并提供操作技巧。
回顾性分析63例行LRH且采用或未采用普林格尔手法的患者。我们研究了普林格尔手法在LRH中的有效性和安全性。统计分析采用学生t检验、χ²检验、曼-惠特尼U检验、威尔科克森符号秩检验和费舍尔精确检验。
19例患者在LRH中采用了普林格尔手法，44例患者未采用该手法。倾向评分匹配后，手术时间、估计失血量和术后并发症发生率方面无显著差异（分别为P = 0.973、0.120，不可用）。然而，普林格尔手法组中转开腹再次肝切除术（ORH）的发生率显著更低（P = 0.034）。在许多情况下，转开腹的原因是未采用入肝血流阻断，导致无法控制术中出血。术后收集的实验室数据显示，无论是否阻断血流，两组之间均无显著差异。
使用各种手术器械可安全地实施采用普林格尔手法的LRH。然而，对于有胆囊切除术史或肝5段切除术史的患者，实施普林格尔手法通常具有挑战性，需要谨慎操作。
