Comparison of the application between infrahepatic inferior vena cava clamping and selective hepatic venous occlusion in hepatectomy

doi:10.3877/cma.j.issn.2095-3232.2016.04.010

Abstract

Abstract:

Objective

To compare the safety and efficacy between infrahepatic inferior vena cava clamping and selective hepatic venous occlusion in hepatectomy.

Methods

Clinical data of 1 952 patients who underwent hepatectomy with infrahepatic inferior vena cava clamping or selective hepatic venous occlusion between January 2006 and December 2013 were retrospectively analyzed. The data were derived from the database of hepatic vascular control jointly set up by over 100 hospitals nationwide. Among them, 1 275 were males and 677 were females, aged from 1 to 85 years old with a median age of 52 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the infrahepatic inferior vena cava clamping group (n=1 314) and selective hepatic venous occlusion group (n=638) according to the different hepatic blood occlusion. The intraoperative blood loss in two groups was compared using Mann-Whitney U test. And the intraoperative transfusion rate and incidence of postoperative complications were compared using Chi-square test.

Results

The intraoperative blood loss in the infrahepatic inferior vena cava clamping group was 250(10-6 000) ml, significantly less than 300(10-8 000) ml in the selective hepatic venous occlusion group (U=2.192, P<0.05). The transfusion rate was 22.8% and the incidence of postoperative complications was 34.2% in the infrahepatic inferior vena cava clamping group, significantly lower than 27.9% and 41.2% in the selective hepatic venous occlusion group (χ²=6.156, 9.218; P<0.05).

Conclusions

Compared with selective hepatic venous occlusion, infrahepatic inferior vena cava clamping is more convenient for hepatectomy, and it can more evidently decrease the intraoperative blood loss and reduce the incidence of postoperative complications.

Key words: Hepatectomy, Infrahepatic inferior vena cava clamping, Selective hepatic venous exclusion, Postoperative complications

Chao Wu, Xiaoping Chen, Jingjing Yu, Wei Zhang. Comparison of the application between infrahepatic inferior vena cava clamping and selective hepatic venous occlusion in hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(04): 244-248.

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References 20

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组别	例数	性别		年龄（岁，）	HBsAg阳性（例）	肝功能Child-Pugh分级（例）		ASA评分Ⅰ+Ⅱ级（例）	术前Plt（×10⁹/L，）	术前PT（s，）
组别	例数	男	女	年龄（岁，）	HBsAg阳性（例）	A级	B级	ASA评分Ⅰ+Ⅱ级（例）	术前Plt（×10⁹/L，）	术前PT（s，）
肝下下腔静脉阻断组	1 314	945	369	52±12	749	1 048	246	1 076	194±86	12.4±2.2
选择性肝静脉阻断组	638	330	308	52±12	257	460	178	536	201±79	12.3±2.2
统计值	?	χ²=77.309		t=0.157	χ²=48.067	χ²=19.710		χ²=1.348	t=-1.669	t=1.197
P值	?	<0.001		0.875	<0.001	<0.001		0.246	0.095	0.232

组别	例数	性别		年龄（岁，）	HBsAg阳性（例）	肝功能Child-Pugh分级（例）		ASA评分Ⅰ+Ⅱ级（例）	术前Plt（×10⁹/L，）	术前PT（s，）
组别	例数	男	女	年龄（岁，）	HBsAg阳性（例）	A级	B级	ASA评分Ⅰ+Ⅱ级（例）	术前Plt（×10⁹/L，）	术前PT（s，）
肝下下腔静脉阻断组	1 314	945	369	52±12	749	1 048	246	1 076	194±86	12.4±2.2
选择性肝静脉阻断组	638	330	308	52±12	257	460	178	536	201±79	12.3±2.2
统计值	?	χ²=77.309		t=0.157	χ²=48.067	χ²=19.710		χ²=1.348	t=-1.669	t=1.197
P值	?	<0.001		0.875	<0.001	<0.001		0.246	0.095	0.232

组别	例数	肝切除范围（例）		第一肝门阻断（例）	第一肝门阻断时间（min，）	手术时间（min，）	术中出血量[ml，M(Q_R)]	术中输血率（%）
组别	例数	大	小	第一肝门阻断（例）	第一肝门阻断时间（min，）	手术时间（min，）	术中出血量[ml，M(Q_R)]	术中输血率（%）
肝下下腔静脉阻断组	1 314	424	890	940	17±9	207±94	250（10～6 000）	22.8
选择性肝静脉阻断组	638	229	409	447	18±8	216±99	300（10～8 000）	27.9
统计值	?	χ²=2.536		χ²=0.454	t=-1.612	t=-1.765	U=2.192	χ²=6.156
P值	?	0.111		0.500	0.107	0.078	0.028	0.013

组别	例数	肝切除范围（例）		第一肝门阻断（例）	第一肝门阻断时间（min，）	手术时间（min，）	术中出血量[ml，M(Q_R)]	术中输血率（%）
组别	例数	大	小	第一肝门阻断（例）	第一肝门阻断时间（min，）	手术时间（min，）	术中出血量[ml，M(Q_R)]	术中输血率（%）
肝下下腔静脉阻断组	1 314	424	890	940	17±9	207±94	250（10～6 000）	22.8
选择性肝静脉阻断组	638	229	409	447	18±8	216±99	300（10～8 000）	27.9
统计值	?	χ²=2.536		χ²=0.454	t=-1.612	t=-1.765	U=2.192	χ²=6.156
P值	?	0.111		0.500	0.107	0.078	0.028	0.013

组别	例数	总体并发症发生率（%）	Ⅰ级（例）	Ⅱ级（例）
组别	例数	总体并发症发生率（%）	伤口感染	心律失常	肺部感染	尿路感染	少量胸腔积液	腹腔积液
肝下下腔静脉阻断组	1 314	34.2	62	13	39	6	94	146
选择性肝静脉阻断组	638	41.2	35	8	16	4	66	77
统计值	?	χ²=9.218	χ²=0.536	χ²=0.282	χ²=0.332	校正χ²=0.244	χ²=5.812	χ²=0.389
P值	?	0.002	0.505	0.642	0.564	0.737	0.018	0.544
组别	例数	Ⅲ级（例）			Ⅳ级（例）			Ⅴ级（例）
组别	例数	胆漏	中大量胸腔积液	术后出血	肝衰竭	肾衰竭	肺栓塞	死亡
肝下下腔静脉阻断	1 314	21	24	27	7	5	2	3
选择性肝静脉阻断	638	13	10	20	5	4	2	3
统计值	?	χ²=0.485	χ²=0.168	χ²=2.132	校正χ²=0.127	校正χ²=0.158	校正χ²=0.042	校正χ²=0.221
P值	?	0.467	0.854	0.157	0.543	0.485	0.601	0.399

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