Advances in Techniques of Hepatic Blood Occlusion in Hepatectomy
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Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy.Methods The related literatures were reviewed and analysed.Results There were many techniques of hepatic blood occlusion.The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion.Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged.Total vascular exclusion and other techniques were rarely used.Conclusion To reduce blood loss in hepatectomy and make patient safe,based on the situation of the patient,the technique should be ingeniously selected.Keywords:
Vascular occlusion
Hepatic veins
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目的 探讨肝静脉阻断技术在复杂肝脏肿瘤切除术中防止肝静脉破裂大出血及空气栓塞的作用.方法 对105例肝脏肿瘤手术切除患者施行了1根以上主肝静脉阻断.所有肿瘤均位于第二肝门并侵犯或压迫1根以上主肝静脉.肝静脉阻断方法采用绕线结扎、血管带阻断或血管夹及心耳钳夹闭法.结果 105例中无一例肝静脉分离破裂.施行半肝全血流阻断41例(右侧27例,左侧14例),交替半肝全血流阻断4例,第一肝门阻断加部分肝静脉阻断45例,第一肝门阻断加全部肝静脉阻断(不阻断下腔静脉的全肝血流阻断)15例.其中46例同时行第三肝门分离.105例肿瘤顺利切除.结论 肝静脉阻断技术是一种安全、有效的血流阻断技术.不阻断下腔静脉的全肝血流阻断术既能控制术中出血,又能保证全身血流动力学稳定。
Hepatic veins
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It is important to reduce blood loss and protect the function of reserved liver during hepatectomy. Selective hepatic vascular occlusion can keep the blood supply of reserved liver and make blood loss less than other methods of blood occlusion, so it helps more to the recovery of liver function. In summary, promotion and application of this technology is worth while. This article reviews the developing progress and the latest studies of selective hepatic blood occlusion to introduce the latest advancement in this area.
Key words:
Hepatectomy; Hepatic vascular exclusion; Hepatic hilum
Hilum (anatomy)
Blood supply
Vascular occlusion
Liver function
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Objective: To investigate the clinical application of the half-hepatic blood occlusion for hepatectomy to decrease bleeding during the operation,relieve liver functional impairment and decrease operation risk.Methods: Sixteen cases of half-hepatic blood flow occlusion intra-operation underwent operations of hepatectomy and the stones were removed by cholangiotomy.The postoperative complications,the residual stone in intrahepatic cholelithes,the reoperation rate and the index of liver function were evaluated.Results: After operation,all cases obtained quick recovery of the liver function,and no death and complications occurred.Conclusion: The hemi-hepatic blood flow occlusion for hepatectomy was a feasible,reasonable and effective procedure due to its good control of blood loss,retention of blood circulation in the healthy side of the liver,and lessening of intraoperation and postoperation liver dysfunction.
Liver function
Hepatic function
Vascular occlusion
Hepatic dysfunction
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Objective: To investigate the efficacy of selective hemihepatic vascular occlusion in hepatectomy for cavernous hemangioma. Methods: The clinical data of 104 patients with hepatic cavernous hemangioma undergoing surgical resection from January 2006 to January 2011 were retrospectively analyzed.Of the patients,selective hemihepatic vascular occlusion was performed in 26 cases(group A),and the Pringle maneuver was performed in 78 patients(group B).The influence of the two approaches on the parameters that included intraoperative conditions,postoperative liver function and incidence of complications were compared and analyzed. Results: Operations were successfully performed in all the 104 patients.There were no statistical differences in intraoperative bleeding,blood transfusion volume,hepatic inflow occlusion time,blood oxygen saturation,time to intestinal function recovery and incidence of complication between the two groups(all P0.05),but the alterations of peripheral blood pressure and arterial pulse in group B were more evident than those in group A(both P0.01).The postoperative changes of liver function parameters such as ALT,AST,ALB and TBIL in group B were more favorable than those in group A,and all the differences had statistical significance(P0.05 or P0.01). Conclusion: Using selective hemihepatic vascular occlusion in hepatic resection of cavernous hemangiom can effectively reduce the impact of hepatic blood flow occlusion on systemic hemodynamics,alleviate hepatic ischemia–reperfusion injury,and thereby facilitate recovery of postoperative liver function.
Vascular occlusion
Liver function
Liver Hemangioma
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Hepatectomy is the main option of treatment for liver cancer,and how to control the blood loss is an important issue for the recovery of patients.Continuous hepatic vascular occlusion(Pringle maneuver)is the oldest and simplest way for vascular occlusion and still used in clinical practice.But continuous hepatic vascular occlusion often gives rise to postischemic reperfusion injury due to clamping the portal vein and the hepatic artery in the hepatic pedicle.So intermittent clamping or hemihepatic vascular occlusion is recommended in complex liver resections or for patients with liver cirrhosis.Total hepatic vascular exclusion has the advantages of occlusion of vascular inflow and outflow of the liver,and is mainly used for patients with tumors invading the caval veins.Major hepatic veins and limited inferior vena cava reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins.It is crucial to know how to select the optimal methods of hepatic vascular occlusion according to the specific conditions.Focusing on this issue,we have reviewed and evaluated various methods and relevant researches in this paper.
Key words:
Liver neoplasms; Hepatectomy; Vascular occlusion
Vascular occlusion
Hepatic veins
Liver Cancer
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Objective To investigate the selectivity of the liver blood flow into and out of hepatic blood flow occlusion in liver resection surgery.Methods The clinical data of 14 cases with selectivity of the liver blood flow into and out of hepatic blood flow occlusion in liver resection surgery.Results The therapeutic effect was fine without bleeding and complications.Conclusion Selective blood inflow and outflow of the liver hepatic blood flow occlusion can achieve total hepatic blood flow with classical techniques,avoid massive bleeding and air embolism,but also easy to cause systemic blood flow mechanical disturbance,decrease the incidence of liver failure.
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Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People's Hospital from 2004. 1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp.Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.
Key words:
Hemangioma; Hepatectomy; Hepatic veins occlusion; Porta hepatis
Air embolism
Left Hepatic Duct
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Objective To evaluate hepatic veins exclusion for the prevention of massive bleeding and air embolism during hepatectomy. Methods Seventy-one cases of liver tumours underwent hepatectomy with more than one major hepatic vein branches being temporarily clamped. All the tumours involved the second porta hepatis and at lest one main hepatic veins. Serrefine, tourniquet and auricular clamp were used for hepatic vein exclusion. Results Of the 71 patients, tumor involved hepatic veins were ligated in 28 cases, temporarily blockaded with tourniquet in 26 cases, and with serrefine in 17 cases. Right hepatic veins were temporarily occluded in 34 cases, both right and middle hepatic veins in 2, common trunk of left and middle hepatic veins in 24, branchs of left and middle hepatic veins in 2, total hepatic veins in 9 cases. Thirty-five cases underwent hemihepatic vascular occlusion, and 4 with alternative hemihepatic vascular occlusion. Pringle's maneuver and partial hepatic veins occlusion were adopted in 23 cases, Pringle's maneuver and total hepatic veins occlusion were used in 9. All the tumours were removed completely and successfully. Conclusion Hepatic veins occlusion for hepatectomy is safe, effective to prevent dangerous bleeding and air embolism with less interference to hemodynamics than total hepatic blood occlusion.
Hepatic veins
Vascular occlusion
Right gastric vein
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Liver circulation
Liver Cancer
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Objective To evaluate the clinical values of selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas.Methods Forty patients with large hepatocellular carcinomas who underwent hepatectomy with selective hepatic inflow and outflow occlusion of tumor-bearing liver were retrospectively analyzed.Results All the 40 patients underwent hepatectomy successfully.The blood losts during the operation was 100-800 mL(average 360 mL).The operation time was 90-150 min(average 116 min).Intraoperative blood transfusion was not performed in twenty-five patients.All patients recovered completely and were discharged without liver function failure or other severe complications.There was no perioperative death.Conclusions Selective hemihepatic vascular occlusion in hepatectomy for large hepatocellular carcinomas is a safe and effective method with advantages of controlling hemorrhage,decreasing liver damage and gut barrier injury,avoiding air embolism and preventing metastasis.
Vascular occlusion
Liver function
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