Choi Jin-Uk, Hwang Shin, Chung I-Ji, Kang Sang-Hyun, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Kim Ki-Hun, Song Gi-Won, Jung Dong-Hwan, Park Gil-Chun, Yoon Young-In, Cho Hui-Dong, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Transplant. 2020 Mar 31;34(1):55-61. doi: 10.4285/kjt.2020.34.1.55.
Living donor liver transplantation (LDLT) causes bleeding in recipients during the careful preservation of most perihilar structures during this surgery. This case-control study aimed to analyze the effect of prolonged hepatic inflow occlusion (PHIO) when applied during recipient hepatectomy in LDLT.
The study group comprised patients who underwent PHIO with Model for End-Stage Liver Disease (MELD) scores ranging from 26 to 35 (n=20). The following two control groups were selected according to their MELD scores: the low-MELD score group (MELD scores of 15-20, n=40) and the high-MELD score group (MELD scores of 26-35, n=40). Total dissection time for hepatic mobilization and dissection and blood loss during these procedures were compared between the two groups.
In the PHIO study group, mean total dissection time and mean PHIO duration were 226.3±59.4 and 68.2±19.1 minutes, respectively. Twelve patients underwent PHIO twice, and the other eight patients underwent PHIO once. The low-MELD score control group and the PHIO study group showed similar dissection duration (216.0±43.9 vs. 226.3±59.4 minutes, P=0.82) and similar blood loss volume during dissection (2,112.5±1,614.9 vs. 2,350.0±951.9 mL, P=0.17). The high-MELD score control group and the PHIO study group showed similar dissection duration (241.0±41.9 vs. 226.3±59.4 minutes, P=0.71), but the PHIO group showed a significantly lower blood loss during dissection than the high-MELD score group (2,350.0±951.9 vs. 2,815.0±1,813.9 mL, P=0.002). During and after PHIO, no adverse complication was observed, except for transient splanchnic congestion.
Our findings suggest that PHIO is a simple effective method to reduce intraoperative bleeding during hepatic mobilization and dissection during LDLT operation requiring difficult dissection.
活体肝移植（LDLT）手术在仔细保留大多数肝门周围结构时会导致受者出血。本病例对照研究旨在分析在LDLT受者肝切除术中应用延长肝血流阻断（PHIO）的效果。
研究组包括终末期肝病模型（MELD）评分在26至35之间的接受PHIO的患者（n = 20）。根据MELD评分选择以下两个对照组：低MELD评分组（MELD评分为15 - 20，n = 40）和高MELD评分组（MELD评分为26 - 35，n = 40）。比较两组在肝脏游离和解剖过程中的总解剖时间以及这些过程中的失血量。
在PHIO研究组中，平均总解剖时间和平均PHIO持续时间分别为226.3±59.4分钟和68.2±19.1分钟。12例患者接受了两次PHIO，其他8例患者接受了一次PHIO。低MELD评分对照组和PHIO研究组的解剖持续时间相似（216.0±43.9对226.3±59.4分钟，P = 0.82），解剖过程中的失血量也相似（2,112.5±1,614.9对2,350.0±951.9 mL，P = 0.17）。高MELD评分对照组和PHIO研究组的解剖持续时间相似（241.0±41.9对226.3±59.4分钟，P = 0.71），但PHIO组在解剖过程中的失血量明显低于高MELD评分组（(2,350.0±951.9对2,815.0±1,813.9 mL，P = 0.002）。在PHIO期间及之后，除了短暂的内脏充血外，未观察到不良并发症。
我们的研究结果表明，PHIO是一种在需要困难解剖的LDLT手术中减少肝脏游离和解剖过程中术中出血的简单有效方法。
