To investigate the application value of partial occlusion of the inferior vena cava in hepatectomy.

Clinical data of 100 patients who underwent hepatectomy in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from September 2012 to September 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the different control method of blood loss, the patients were divided into three groups: the total occlusion of the inferior vena cava group (total occlusion group, n=28), the partial occlusion of the inferior vena cava group (partial occlusion group, n=24) and the non-occlusion of the inferior vena cava group (non-occlusion group, n=48). In the total occlusion group, 24 cases were males and 4 were females, aged (68±9) years old on average, and total occlusion of porta hepatis combined with inferior vena cava was performed. In the partial occlusion group, 21 were males and 3 were females, aged (70±10) years old, and partial occlusion of porta hepatis combined with 2/3 of the inferior vena cava was performed. In the non-occlusion group, 41 were males and 7 were females, aged (67±11) years old, and only porta hepatis occlusion was performed. The perioperative conditions including intraoperative blood loss, blood transfusion, intra- and post-operative complications were observed. The perioperative conditions were compared by one-way analysis of variance and LSD-t test or t test. The rates were compared by Chi-square test or Fisher's exact probability test.

The intraoperative blood loss in the total and partial occlusion groups was respectively (388±183) and (406±178) ml, significantly less than (797±378) ml in the non-occlusion group (LSD-t=-2.648, -2.109; P<0.05). The number of blood transfusion in the total and partial occlusion group was respectively 2 and 1, significantly less than 12 in the non-occlusion group (χ²=3.752, 7.328; P<0.05). The central venous pressure after occlusion of inferior vena cava in the total and partial occlusion group was respectively (3.2±1.8) and (3.6±1.4) cmH₂O (1 cmH₂O=0.098 kPa), significantly lower than (11.2±2.3) and (11.3±2.1) cmH₂O before surgery (LSD-t=-2.341, -1.927; P<0.05). Two cases of hypotension were observed in the total occlusion group after occlusion of inferior vena cava, whereas no evident pressure fluctuation was observed in the partial- and non-occlusion group, and significant differences were observed (P<0.05). The incidence of postoperative complications in the total-, partial- and non-occlusion group was respectively 29% (8/28), 29% (7/24) and 31% (15/48), and no significant difference was observed (χ²=0.720, P>0.05). No death or severe complications were observed in three groups during and after surgery.

Partial occlusion of the inferior vena cava can not only achieve similar clinical efficacy as the total occlusion, but also has the advantage of maintaining the hemodynamic stability. It is a safe and efficacious method for blood loss control.