Effect of different porta hepatis occlusion on liver function of patients after hepatectomy for liver cancer

doi:10.3877/cma.j.issn.2095-3232.2019.02.009

Abstract

Abstract:

Objective

To compare the effect of different porta hepatis occlusion on the liver function of patients after hepatectomy for primary liver cancer (PLC).

Methods

Clinical data of 194 patients with PLC who underwent hepatectomy in the Second Affiliated Hospital of Air Force Medical University from January 2015 to November 2017 were retrospectively analyzed. Among them, 169 patients were male and 25 were female, aged (52±10) years. According to the different occlusion used, all patients were divided into Pringle maneuver group (Pringle group, n=51), hemi-hepatic vascular occlusion group (hemi-hepatic group, n=96) and selective hepatic vascular occlusion group (selective group, n=47). The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperative indexes, perioperative conditions and postoperative liver function were compared among three groups by one-way ANOVA and LSD-t test.

Results

The operation time and length of hospital stay in hemi-hepatic and selective groups were (230±20) min, (14.4±1.8) d and (220±20) min, (14.1±1.8) d respectively, significantly shorter than (256±18) min and (17.8±2.1) d in Pringle group (LSD-t=-27.1, -3.5 and -35.9, -3.7; P<0.05). At postoperative 3 d, ALT, AST and TB in selective group were (327±31) U/L, (195±20) U/Land (30±3) μmol/L, significantly lower compared with (428±40) U/L, (320±42) U/L and (39±6) μmol/L in Pringle group and (386±40) U/L, (223±33) U/L and (40±6) μmol/L in hemi-hepatic group (LSD-t=-100.6, -124.4, -8.9 and -56.4, -25.8, -9.6; P<0.05). ALT and AST in hemi-hepatic group were significantly lower than those in Pringle group (LSD-t=-44.2, -98.6; P<0.05).

Conclusions

Compared with Pringle maneuver, hepatectomy for liver cancer with hemi-hepatic or selective hepatic vascular occlusion has the advantages of shorter operation time and length of hospital stay, and faster recovery of liver function after surgery, especially the selective hepatic vascular occlusion.

Key words: Liver neoplasms, Hepatectomy, Vascular occlusion

Tao Yang, Xilin Du, Kai Tan, Baishu Dai, Ying Duan. Effect of different porta hepatis occlusion on liver function of patients after hepatectomy for liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(02): 118-121.

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References 21

[1]	Sanjay P, Ong I, Bartlett A, et al. Meta-analysis of intermittent Pringle manoeuvre versus no Pringle manoeuvre in elective liver surgery[J]. ANZ J Surg, 2013, 83(10):719-723.
[2]	Wijesurendere CN, Silva FH, Pathirana AA, et al. Pringle manoeuvre versus selective hepatic vascular exclusion: outcome of a case series in a tertiary referral centre[J]. Ceylon Med J, 2014, 59(4):139-140.
[3]	Schiergens TS, Rentsch M, Kasparek MS, et al. Impact of perioperative allogeneic red blood cell transfusion on recurrence and overall survival after resection of colorectal liver metastases[J]. Dis Colon Rectum, 2015, 58(1):74-82.
[4]	Lee EC, Kim SH, Park H, et al. Survival analysis after liver resection for hepatocellular carcinoma: a consecutive cohort of 1002 patients[J]. J Gastroenterol Hepatol, 2017, 32(5):1055-1063.
[5]	Goubran HA, Elemary M, Radosevich M, et al. Impact of transfusion on cancer growth and outcome[J]. Cancer Growth Metastasis, 2016(9):1-8.
[6]	黄安华，黄伟．Pringle法联合肝下下腔静脉阻断法在肝癌切除术中的应用[J]．中国现代普通外科进展，2016, 19(7):570-572.
[7]	韩秀国，马宽生，夏锋，等．肝硬化肝癌和无肝硬化肝癌患者围术期肝衰竭和死亡的相关因素分析[J]．中华消化外科杂志，2016, 15(6):605-614.
[8]	van Riel WG, van Golen RF, Reiniers MJ, et al. How much ischemia can the liver tolerate during resection?[J]. Hepatobiliary Surg Nutr, 2016, 5(1):58-71.
[9]	Strobel O, Büchler MW. Intermittent Pringle manoeuvre: no reduction of blood loss according to recent RCT[J]. Chirurg, 2012, 83(11):994.
[10]	郝胜华，杨湘武，杨文龙，等．间歇性肝门阻断是原发性肝癌术后早期肝内复发的一项危险因素[J]．中华肝胆外科杂志，2013, 19(5):321-324.
[11]	Su Y, Pan H, Guo Z, et al. Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats[J]. Dig Dis Sci, 2015, 60(2):414-419.
[12]	Yang Y, Zhao LH, Fu SY, et al. Selective hepatic vascular exclusion versus pringle maneuver in partial hepatectomy for liver hemangioma compressing or involving the major hepatic veins[J]. Am Surg, 2014, 80(3):236-240.
[13]	Fu SY, Lau WY, Li GG, et al. A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy[J]. Am J Surg, 2011, 201(1):62-69.
[14]	Li M, Zhang T, Wang L, et al. Selective hemihepatic vascular occlusion versus Pringle maneuver in hepatectomy for primary liver cancer[J]. Med Sci Monit, 2017(23):2203-2210.
[15]	刘昌军，杨尽晖，易为民，等．右半肝血流阻断在肝右后叶解剖性切除术中的应用 [J/CD]．中华肝脏外科手术学电子杂志，2016, 5(2):77-80.
[16]	严律南，曾勇，林琦远．半肝血流阻断下肝能量代谢变化的研究[J]．中华肝胆外科杂志，2000, 6(1):10-12.
[17]	Hackl C, Schlitt HJ, Renner P, et al. Liver surgery in cirrhosis and portal hypertension[J]. World J Gastroenterol, 2016, 22(9):2725-2735.
[18]	黎福良，车斯尧，黄思敏，等．半肝血流阻断在肝癌半肝切除中的临床研究[J]．肝胆胰外科杂志，2015, 27(5):424-426．
[19]	周进学，王征征，李庆军，等．精准肝切除治疗邻近重要管道肝肿瘤的临床疗效[J]．中华消化外科杂志，2017, 16(2):139-143．
[20]	Ko S, Kirihataya Y, Matsumoto Y, et al. Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection[J]. World J Hepatol, 2016, 8(8):411-420.
[21]	Si-Yuan F, Yee LW, Yuan Y, et al. Pringle manoeuvre versus selective hepatic vascular exclusion in partial hepatectomy for tumours adjacent to the hepatocaval junction: a randomized comparative study[J]. Int J Surg, 2014, 12(8):768-773.

组别	例数	性别（例）		年龄（岁，±s）	Child-Pugh分级（例）		ICGR15（±s）	ALT（U/L，±s）	AST（U/L，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	肿瘤最大直径（cm，±s）
组别	例数	男	女	年龄（岁，±s）	A级	B级	ICGR15（±s）	ALT（U/L，±s）	AST（U/L，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	肿瘤最大直径（cm，±s）
Pringle组	51	45	6	53±11	40	11	0.072±0.013	44±7	49±8	21.3±1.5	40±4	6.4±2.1
半肝组	96	81	15	53±90	88	8	0.075±0.019	42±8	47±7	24.9±1.7	39±4	6.7±1.9
选择组	47	43	4	52±12	42	5	0.069±0.015	44±7	47±8	22.4±1.1	39±5	6.3±1.5
统计值		χ²=1.5		F=0.1	χ²=5.6		F=1.6	F=1.1	F=2.0	F=2.5	F=1.6	F=0.5
P值		0.472		0.885	0.062		0.203	0.338	0.141	0.083	0.199	0.616

组别	例数	性别（例）		年龄（岁，±s）	Child-Pugh分级（例）		ICGR15（±s）	ALT（U/L，±s）	AST（U/L，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	肿瘤最大直径（cm，±s）
组别	例数	男	女	年龄（岁，±s）	A级	B级	ICGR15（±s）	ALT（U/L，±s）	AST（U/L，±s）	TB（μmol/L，±s）	ALB（g/L，±s）	肿瘤最大直径（cm，±s）
Pringle组	51	45	6	53±11	40	11	0.072±0.013	44±7	49±8	21.3±1.5	40±4	6.4±2.1
半肝组	96	81	15	53±90	88	8	0.075±0.019	42±8	47±7	24.9±1.7	39±4	6.7±1.9
选择组	47	43	4	52±12	42	5	0.069±0.015	44±7	47±8	22.4±1.1	39±5	6.3±1.5
统计值		χ²=1.5		F=0.1	χ²=5.6		F=1.6	F=1.1	F=2.0	F=2.5	F=1.6	F=0.5
P值		0.472		0.885	0.062		0.203	0.338	0.141	0.083	0.199	0.616

组别	例数	手术时间（min）	肝门阻断时间（min）	术中出血量（ml）	住院时间（d）
Pringle组	51	256±18	29±4	828±68	17.8±2.1
半肝组	96	230±20	25±5	815±62	14.4±1.8
选择组	47	220±20	23±4	791±61	14.1±1.8
F值		55.6	2.6	0.2	78.6
P值		<0.001	0.081	0.827	<0.001

组别	例数	手术时间（min）	肝门阻断时间（min）	术中出血量（ml）	住院时间（d）
Pringle组	51	256±18	29±4	828±68	17.8±2.1
半肝组	96	230±20	25±5	815±62	14.4±1.8
选择组	47	220±20	23±4	791±61	14.1±1.8
F值		55.6	2.6	0.2	78.6
P值		<0.001	0.081	0.827	<0.001

组别	例数	ALT（U/L）	AST（U/L）	TB（μmol/L）
Pringle组	51	428±40^a,b	320±42^a,b	39±6^a,b
半肝组	96	386±40^a^,b	223±33^a^,b	40±6^a,b
选择组	47	327±31^a,b	195±20^a,b	30±3^a,b
F值		100.3	242.1	62.0
P值		<0.001	<0.001	<0.001

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