Guo Lianming, Gong Weiqiang
Department of Hepatobiliary & Pancreatic Surgery, Weifang People's Hospital, Weifang, Shandong Province, China.
Ann Med Surg (Lond). 2024 May 22;86(7):4083-4091. doi: 10.1097/MS9.0000000000002165. eCollection 2024 Jul.
Application of hemihepatic inflow occlusion (HIO) and total hepatic inflow occlusion (TIO) are two common approaches for hepatectomy. However, their efficacy and safety remain controversial.
Randomized control trials (RCTs) published before 15t January 2023 were included by a systematic literature search, which compared the clinical outcomes between HIO and TIO. The primary outcome was the estimated blood loss (EBL). Three independent authors screened and extracted the data and resolved disagreements by consensus. The ROB2.0 tool was used for evaluating the risk of bias.
A total of 1026 patients (511 TIO and 515 HIO) from 9 studies were analyzed in the meta-analyses. The EBL between TIO and HIO group was similar, while HIO was associated with a lower proportion of patients required transfusion (=0.002), less units of blood transferred (<0.001) and a lower overall complication rate (=0.008). There were no significant differences between TIO and HIO in mortality (=0.37), length of stay (=0.97), bile leak rate (=0.58), liver failure rate (=0.96), reoperation rate (=0.48), postoperative haemorrhage rate (=0.93) and incidence of postoperative ascites (=0.96). The operative time of HIO was usually no more than 15 min longer than that of TIO (<0.001).
Comparing with the TIO, HIO increased the operative time and failed to further reduce the EBL in patients with liver surgery. However, despite the complexity of the operation, HIO was recommended due to the similar effect on the consumption of blood products and the postoperative complications.
半肝血流阻断（HIO）和全肝血流阻断（TIO）是肝切除术的两种常用方法。然而，它们的疗效和安全性仍存在争议。
通过系统文献检索纳入2023年1月15日前发表的随机对照试验（RCT），比较HIO和TIO的临床结局。主要结局是估计失血量（EBL）。由三位独立作者筛选和提取数据，并通过共识解决分歧。使用ROB2.0工具评估偏倚风险。
荟萃分析中分析了来自9项研究的总共1026例患者（511例TIO和515例HIO）。TIO组和HIO组之间的EBL相似，而HIO组需要输血的患者比例较低（=0.002），输血单位较少（<0.001），总体并发症发生率较低（=0.008）。TIO和HIO在死亡率（=0.37）、住院时间（=0.97）、胆漏率（=0.58）、肝衰竭率（=0.96）、再次手术率（=0.48）、术后出血率（=0.93）和术后腹水发生率（=0.96）方面无显著差异。HIO的手术时间通常比TIO长不超过15分钟（<0.001）。
与TIO相比，HIO增加了手术时间，并且未能进一步减少肝脏手术患者的EBL。然而，尽管手术复杂，但由于对血液制品消耗和术后并发症的影响相似，仍推荐使用HIO。
