Effect of difference of central venous pressure on intraoperative blood loss in laparoscopic hepatectomy for hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2024.02.007

Abstract

Abstract:

Objective

To evaluate the effect of difference of central venous pressure (ΔCVP) before and during liver transection on intraoperative blood loss in laparoscopic hepatectomy for hepatocellular carcinoma (HCC).

Methods

Clinical data of 57 HCC patients who underwent laparoscopic hepatectomy in the No.909 Hospital from June 2021 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. 57 patients were treated with controlled low central venous pressure (LCVP), and the ΔCVP before and during liver transection was calculated. According to the median intraoperative blood loss of 215 ml, 57 patients were divided into group A (intraoperative blood loss of≥215 ml, n=29) and group B (intraoperative blood loss of<215 ml, n=28). The predictive effect of ΔCVP on intraoperative blood loss was assessed by the ROC curve. The correlation between ΔCVP and intraoperative blood loss was determined by Pearson's linear analysis. The influencing factors of intraoperative blood loss were identified by univariate and multivariate Logistic regression analyses.

Results

ROC curve analysis showed that the area under the ROC curve (AUC) of ΔCVP for predicting intraoperative blood loss was 0.867. The maximum value of Youden's index was 0.648. The optimal threshold value of ΔCVP was 5.5 cmH₂O (1 cmH₂O=0.098 kPa). The sensitivity was 0.786 and the specificity was 0.862 (95%CI: 0.765-0.969, P<0.05). Pearson's correlation analysis indicated that ΔCVP was negatively correlated with intraoperative blood loss (r=-0.781, P<0.05). Univariate analysis showed that the incidence of intraoperative bleeding in patients with ΔCVP <5.5 cmH₂O, liver cirrhosis, fatty liver, tumor diameter of ≥10 cm, space-occupying effect and HCC at difficult sites in group A were significantly higher than those in group B (χ²=24.097, 6.908, 5.179, 5.695, 5.221, 8.211; P<0.05). Multivariate Logistic analysis showed that ΔCVP of<5.5 cmH₂O, liver cirrhosis and HCC at difficult sites were the independent risk factors for intraoperative bleeding of laparoscopic hepatectomy (OR=38.812, 12.127, 12.573; P<0.05).

Conclusions

The amount of blood loss during laparoscopic hepatectomy is correlated with ΔCVP before and during liver transection. Maintaining CVP at a reasonable level during liver transection by evaluating the CVP before liver transection contributes to reducing the amount of blood loss during hepatectomy.

Key words: Carcinoma, hepatocellular, Laparoscopes, Hepatectomy, Central venous pressure, Liver function, Complications, Blood loss

Jianbin Yang, Jianhua Chen, Wenhua Zhang, Jiandong Liu. Effect of difference of central venous pressure on intraoperative blood loss in laparoscopic hepatectomy for hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 158-162.

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References 21

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参数	A组	B组	统计值	P值
性别（例，男/女）	23/6	21/7	χ²=0.150	0.698
年龄（岁，±s）	51±7	54±7	t=-1.156	0.253
BMI（kg/m²，±s）	23.6±1.0	23.5±1.0	t=0.179	0.858
Child-Pugh A级（例）	24	24	χ²=0.094	1.000
ASA分级（例，Ⅰ/Ⅱ/Ⅲ）	19/8/2	19/7/2	χ²=0.049	0.976
ΔCVP<5.5 cmH₂O（例）	25	6	χ²=24.097	<0.001
肝门阻断（例）	22	20	χ²=0.144	0.704
解剖性肝切除（例）	20	22	χ²=0.678	0.410
肿瘤高分化（例）	13	15	χ²=0.436	0.509
HBsAg阳性（例）	20	19	χ²=0.008	0.928
肝硬化（例）	12	3	χ²=6.908	0.015
脂肪肝（例）	12	4	χ²=5.179	0.038
肿瘤部位（左叶/右叶）	12/17	12/16	χ²=0.013	0.910
肿瘤直径≥10 cm （例）	11	3	χ²=5.695	0.029
占位效应（例）	9	2	χ²=5.221	0.041
困难部位肝癌（例）	13	3	χ²=8.211	0.007

参数	A组	B组	统计值	P值
性别（例，男/女）	23/6	21/7	χ²=0.150	0.698
年龄（岁，±s）	51±7	54±7	t=-1.156	0.253
BMI（kg/m²，±s）	23.6±1.0	23.5±1.0	t=0.179	0.858
Child-Pugh A级（例）	24	24	χ²=0.094	1.000
ASA分级（例，Ⅰ/Ⅱ/Ⅲ）	19/8/2	19/7/2	χ²=0.049	0.976
ΔCVP<5.5 cmH₂O（例）	25	6	χ²=24.097	<0.001
肝门阻断（例）	22	20	χ²=0.144	0.704
解剖性肝切除（例）	20	22	χ²=0.678	0.410
肿瘤高分化（例）	13	15	χ²=0.436	0.509
HBsAg阳性（例）	20	19	χ²=0.008	0.928
肝硬化（例）	12	3	χ²=6.908	0.015
脂肪肝（例）	12	4	χ²=5.179	0.038
肿瘤部位（左叶/右叶）	12/17	12/16	χ²=0.013	0.910
肿瘤直径≥10 cm （例）	11	3	χ²=5.695	0.029
占位效应（例）	9	2	χ²=5.221	0.041
困难部位肝癌（例）	13	3	χ²=8.211	0.007

分组	b	SE（b）	Wald χ²	OR	95%CI	P值
ΔCVP<5.5 cmH₂O	3.659	1.041	12.361	38.812	5.049～298.369	<0.001
肝硬化	2.495	1.158	4.645	12.127	1.254～117.311	0.031
脂肪肝	1.114	1.039	1.150	3.046	0.398～23.320	0.284
肿瘤直径≥10 cm	2.419	1.432	2.853	11.229	0.678～185.883	0.091
占位效应	0.068	2.014	0.001	1.070	0.021～55.405	0.973
困难部位肝癌	2.532	1.135	4.977	12.573	1.360～116.234	0.026

分组	b	SE（b）	Wald χ²	OR	95%CI	P值
ΔCVP<5.5 cmH₂O	3.659	1.041	12.361	38.812	5.049～298.369	<0.001
肝硬化	2.495	1.158	4.645	12.127	1.254～117.311	0.031
脂肪肝	1.114	1.039	1.150	3.046	0.398～23.320	0.284
肿瘤直径≥10 cm	2.419	1.432	2.853	11.229	0.678～185.883	0.091
占位效应	0.068	2.014	0.001	1.070	0.021～55.405	0.973
困难部位肝癌	2.532	1.135	4.977	12.573	1.360～116.234	0.026

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