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MAJOR HEPATIC RESECTION UNDER TOTAL vascular exclusion

Chinese Journal of Cancer Research 2001年第2期13卷 136-139页

作者：季加孚顾晋苏向前焦春雨王怡欧阳晓辉董培德杨成旺 Department of Surgical Oncology Beijing Cancer Hospital School of Oncology Peking University Department of Surgery First Teaching Hospital Inner Mongolia Medical University

Objective: To eveluate major liver resections with vascular exclusion (TVE) in patients with hepatocellular carcinoma (HCC). Methods: Sixteen consecutive, major liver resections performed with TVE in HCC patients were analyzed retrospectively. The patients’ mean ages were 54 years. Ten patients had cirrhosis and eleven patients had chronic hepatitis B. Results: There was no perioperative death and the mean hospital stay was 20 days and the average amount of intraoperative blood transfusion was 400 mL (range 0–2000 mL). Forty-four percent of the patients did not receive intraoperative blood transfusion. The mean total bilirubin(T-BIL) and aspartate aminotransferase (AST) were 24 μ mol/L (range 8–56 μ mol/L) and 56 IU/L (range 10–204 IU/L) measured prior to discharge. Conclusion: In our experience, total vascular exclusion is invaluable in major or difficult liver resections, especially when lesions adjacent to the hepatic veins and vena cava. It is associated with a low blood transfusion requirement and a low incidence of complications. It further obviates the need for dissection of the porta hepatis thus reduces the associated risks. Total vascular exclusion time of 30min appears to be well tolerated, even in patients with cirrhosis.

关键词： HCC hepatic resection vascular exclusion

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Methods of vascular control technique during liver resection:a comprehensive review

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 473-481页

作者： Wan-Yee Lau Eric C.H.Lai Stephanie H.Y.Lau Faculty of Medicine the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND: Significant hemorrhage together with blood transfusion increases postoperative morbidity and mortality of hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. This article aimed to review the current role and status of various techniques of hepatic vascular occlusion during hepatic resection. DATA SOURCES: The relevant manuscripts were identified by searching MEDLINE, and PubMed for articles published between January 1980 and April 2010 using the keywords 'vascular control', 'vascular clamping', 'vascular exclusion' and 'hepatectomy'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: One randomized controlled trial (RCT) and 5 RCTs showed intermittent Pringle maneuver and ischemic preconditioning followed by continuous Pringle maneuver were superior to continuous Pringle maneuver alone, respectively. Two RCTs compared the outcomes of hepatectomy with and without intermittent Pringle maneuver. One showed Pringle maneuver to be beneficial, while the other failed to show any benefit. One RCT showed that ischemic preconditioning had significantly less blood loss than using intermittent Pringle maneuver. Four RCTs evaluated the use of hemihepatic vascular occlusion. One RCT showed it had significantly less blood loss than Pringle maneuver, while the other 3 showed no significant difference. Only 1 RCT showed it had significantly less liver ischemic injury. No RCT had been carried out to assess segmental vascular occlusion. Two RCTs compared the outcomes of total hepatic vascular exclusion (THVE) and Pringle maneuver. One RCT showed THVE resulted in similar blood loss, but a higher postoperative complication. The other RCT showed less blood loss using THVE but the postoperative complication rate was similar. Both studies showed similar degree of liver ischemic injury. Only one RCT showed that selective hepatic vascular exclusion (SHVE) had

关键词： vascular control vascular exclusion hepatectomy liver neoplasm Pringle maneuver

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Precautions in caudate lobe resection: Report of 11 cases

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World Journal of Gastroenterology 2008年第17期14卷 2767-2770页

作者： Zeng-Qing Wen Yi-Qun Yan Jia-Mei Yang Meng-Chao Wu First Department of Hepatic Surgery Eastern HepatobiliarySurgery Hospital Second Military Medical University Shanghai200438 China

AIM： To find the precautions against the safety in caudate lobe resection. METHODS： The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe：（1） selection of appropriate skin incision to obtain excellent exposure of operative field; （2） adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; （3） preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; （4） selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate Iobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate Iobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral Iobectomy for 2 cases and caudate Iobectomy alone for 6 cases. RESULTS： Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation. CONCLUSION： Caudate Iobectomy for liver cance

关键词： Caudate lobe Primary liver cancer Hepatectomy Porta hepatis vascular exclusion

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