Kelly D, Emre S, Guy S R, Sheiner P A, Miller C M, Schwartz M E
Department of Surgery, Mount Sinai Medical Center, New York, NY, USA.
J Am Coll Surg. 1996 Aug;183(2):113-6.
The main morbidity associated with hepatic resection is related to excessive blood loss. Total vascular isolation (TVI) may be used to minimize blood loss in difficult hepatic resection cases.
We reviewed our criteria for use of TVI and our experience in 43 patients who underwent hepatic resection for benign lesions between January 1990 and January 1995. Total vascular isolation was used in 23 patients; 20 resections were performed without TVI.
We found TVI particularly useful for resection of highly vascular lesions, and lesions located centrally or adjacent to major vessels. The use of TVI reduced blood loss in difficult hepatic resections; transfusion requirements for these patients were similar to requirements for the resection of peripheral lesions. Fewer complications directly related to hepatic resection were encountered in the TVI group.
Appropriate use of TVI will improve results after difficult hepatic resections and allow maximal sparing of normal hepatic tissue when operating on benign lesions.
肝切除相关的主要发病因素与失血过多有关。全血管隔离（TVI）可用于在困难的肝切除病例中尽量减少失血。
我们回顾了我们使用TVI的标准以及我们在1990年1月至1995年1月期间对43例因良性病变接受肝切除的患者的经验。23例患者使用了全血管隔离；20例切除未使用TVI。
我们发现TVI对于切除高血运病变以及位于中央或邻近大血管的病变特别有用。TVI的使用减少了困难肝切除中的失血；这些患者的输血需求与外周病变切除的需求相似。TVI组中直接与肝切除相关的并发症较少。
适当使用TVI将改善困难肝切除后的结果，并在对良性病变进行手术时最大程度地保留正常肝组织。
