Abstract：Objective To compare the effects of the hemihepatic blood inflow occlusion with those of the first hepaticportal blood flow occlusion (Pringle) in hepatectomy and investigate the influence of recurrence rates and survival rates of the two Methods.Methods Data of 78 patients with hepatocellular carcinoma underwent hepatectomy in the Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Command from February 2010 to December 2012 were retrospectively analyzed. In group A (n=40) there were 27 males and 13 females with an average age of 52.95 years (range 26-70 years) underwent hepatectomy by hemihepatic blood inflow occlusion combined with controlled low central venous pressure without hepatic portal dissection. In group B (n=38), there were 27 males and 11 females with an average age of 52.32 years (range 32-75 years) by the first hepaticportal blood flow occlusion combined with controlled low central venous pressure without hepatic portal dissection. The bleeding volumes, occlusion duration, operation duration, numbers of cases with blood transfusion, the first day of Child-Pugh grades after operation, the levels of postoperative serum alanine aminotransferase(ALT) and total bilirubin(TBiL) at 1, 3, 7 d, postoperative complications, days of hospitalization were analyzed. Patients were reviewed after the first month and every three months of operation, duration of recovery of postoperative serum ALT and TBiL, recurrence rates and survival rates after operation, and other indexes were analyzed.Results Preoperative Child-Pugh grades, the levels of preoperative serum ALT and TBiL, operation duration, bleeding volume, occlusion durations, numbers of cases underwent blood transfusion, the levels of postoperative serum TBiL at 1, 3, 7 d, postoperative complications, between group A and B were not statistically different (all P values>0.05) . The first day′s deterioration of Child-Pugh grades after operation rate in group A was significant lower than that in group B(χ2=14.404, P＜0.01). The levels of postoperative serum ALT at 1, 3, 7 d and days of hospitalization in group A were significantly lower than those in group B (t=3.363、3.065、3.403、5.663, all P values＜0.01). Duration of recovery of postoperative serum ALTs and TBiLs in group A were significantly shorter than that in group B(t=6.717, 8.508, all P values＜0.01). The 1-, 2- years cumulative recurrence rates in group A were lower than those in group B, and the 1-, 2- years cumulative survical rates in group A were higher than those in group B, but there were no statistically difference between group A and B (all P values>0.05) . Log-rank test was used to compare the cumulative survival rates of 2 years between group A and B , there were no statisticall difference(Log-rank test=0.918, P＜0.01).Conclusions Compared with the hemihepatic blood inflow occlusion combined with controlled low central venous pressure and Pringle occlusion combined with controlled low central venous pressure, hemihepatic blood inflow occlusion without hepatic portal dissection can protect the first hepaticportal structure integrity, reduce the energy metabolism of the remnant and influence of occlusion on systemic hemodynamics, be advantageous to earlier recovery of postoperative liver functions and shorten the length of hospital stay. Thus, hemihepatic blood inflow occlusion is safe and practical, and which is worth promoting in clinic.
黄兴华, 胡还章, 江艺. 半肝入肝血流阻断法与第一肝门血流阻断法在肝癌切除术中应用的比较[J]. 中华解剖与临床杂志, 2015, 20(6): 546-551.
Huang Xinghua, Hu Huanzhang, Jiang Yi. Comparison of hemihepatic blood inflow occlusion without hepaticportal dissection with Pringle′s occlusion in hepatectomy of hepatocellular carcinoma. Chinese Journal of Anatomy and Clinics, 2015, 20(6): 546-551.
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