To investigate the application values of graded hepatic vascular occlusion in hepatectomy.

Clinical data of 618 patients who underwent hepatectomy in Jiangxi Cancer Hospital from January 2011 to December 2017 were retrospectively analyzed. Among them, 531 patients were male and 87 were female with a median age of 45 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Graded hepatic vascular occlusion were applied during the operation. The porta hepatis occlusion was grade Ⅰ, occlusion of porta hepatis and the infrahepatic vena cava was grade Ⅱ, and total hepatic vascular occlusion was grade Ⅲ. The hemostatic effect, cardiac hemodynamic changes and complications of patients were observed.

A total of 650 hepatectomy were performed in 618 patients, graded hepatic vascular occlusion were applied in 623 hepatectomy. Satisfactory surgical fields of liver section were observed in 74%(461/623) of hepatectomy, and comparative good surgical fields in 13%(81/623). GradeⅠocclusion was adopted in 284 hepatectomy, including satisfactory surgical fields of liver section in 221 hepatectomy and comparatively good surgical fields in 28 hepatectomy. GradeⅡocclusion was performed in 266 hepatectomy, including satisfactory surgical fields of liver section in 225 hepatectomy and comparatively good surgical fields in 33 hepatectomy. GradeⅢ occlusion was adopted in 73 hepatectomy, including satisfactory surgical fields of liver section in 15 hepatectomy and comparatively good surgical fields in 20 hepatectomy. After the grade Ⅱ and Ⅲ occlusion, the blood pressure of patients was decreased to different degrees and the heart rate was increased to varying degrees, which gradually recovered after loosening the infrahepatic vena cava occluding band. 2 cases died of fulminant hepatitis after surgery. Postoperatively, liver dysfunction was observed in 2 cases, abdominal hemorrhage in 6, gastrointestinal hemorrhage in 1, pulmonary edema in 4, pulmonary infection in 5, massive effusion within the right pleural cavity in 7 and cognitive dysfunction after anesthesia in 3. All the patients were cured by conservative treatments.

Graded hepatic vascular occlusion can yield clear surgical field in most patients in hepatectomy. The porta hepatis occlusion is simple, safe and effective. Occlusion of infrahepatic vena cava is the key of graded occlusion. Total hepatic vascular occlusion can effectively control the massive hemorrhage caused by hepatic vein injury.