Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xiaohui , WEN Wu ,  WAN Renhua , SAN Renfeng , XIONG Yuanpeng , LUO Laihui , LIU Weiqi , SONG Shengjiang , DONG Xiaoyuan

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P. R. China;

Corresponding author：

WAN Renhua, Email: wrh1966@163.com

Keywords：

hepatectomy; primary hepatocellular carcinoma; hepatic inflow occlusion; Pringle method

DOI：

10.7507/1007-9424.202009037

Video：

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Objective To compare the efficacy and safety of three different modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma.Methods The clinical data of 152 patients with primary hepatocellular carcinoma who underwent hepatectomy and postoperative pathology examination in our department in recent 3 years (2017–2020) were retrospectively analyzed. According to the modes of intraoperative hepatic blood flow occlusion, the patients were divided into three groups: intermittent Pringle method (IPM) group (41 cases), IPM was applied only; hemihepatic group (35 cases), hemihepatic blood flow blocking method was used only; and combined group (76 cases), combined hemihepatic blood flow blocking method and IPM. SPSS software was used to compare the differences of the three groups’ general data, intraoperative blood loss and postoperative liver function indexes. The changes of transaminase levels in the three groups were observed dynamically.Results Baseline data of the three groups were not statistically significant (P>0.05). There were no statistically significant differences in operative time, the number of resected liver segments, blood transfusion rate, incidence of complications, and postoperative length of stay among the three groups (all P>0.05). The intraoperative blood loss of the combined group and the IPM group were significantly less than that of the hemihepatic group (P<0.05). There was no difference in blood loss between the combined group and the IPM group (P>0.05). However, the blocking times in the combined group were significantly less than those in the IPM group (P<0.05). The transaminases in the three groups were close to the preoperative level on the fifth day after operation. Conclusions In hepatectomy of primary hepatocellular carcinoma, the three blocking modes are safe and effective. The combined application of hemihepatic blood flow blocking method and intermittent Pringle method can significantly reduce intraoperative blood loss, reduce the number of blocking, and do not aggravate the liver function injury.

Citation： LI Xiaohui, WEN Wu, WAN Renhua, SAN Renfeng, XIONG Yuanpeng, LUO Laihui, LIU Weiqi, SONG Shengjiang, DONG Xiaoyuan. Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 768-773. doi: 10.7507/1007-9424.202009037 Copy

1.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019 年版). 肿瘤综合治疗电子杂志, 2020, 6(2): 55-85.
2.	张业繁, 蔡建强. 2018《CSCO 原发性肝癌诊疗指南》解读—外科部分. 肝癌电子杂志, 2018, 5(3): 1-3.
3.	Pringle JH. Ⅴ. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
4.	Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet, 1987, 164(2): 155-158.
5.	杨广超, 刘连新. 肝癌肝切除术中血流控制方式选择和评价. 中国实用外科杂志, 2018, 38(4): 383-387.
6.	文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展. 中国普外基础与临床杂志, 2008, 15(4): 299-302.
7.	王亚运, 胡欢, 王世垚, 等. 肝血流阻断技术在肝切除术中的应用. 西北国防医学杂志, 2020, 41(1): 58-63.
8.	Chikamoto A, Beppu T, Masuda T, et al. Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma. Hepatogastroenterology, 2012, 59(116): 1213-1216.
9.	Tong Y, Yang JM, Lai EC, et al. Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection: a comparative study. Hepatogastroenterology, 2011, 58(109): 1307-1311.
10.	张业繁, 陈晓, 李智宇, 等. 术中出血 400 mL 以上是 BCLC B 期肝癌患者预后不良的独立危险因素. 癌症进展, 2017, 15(3): 308-311.
11.	彭承宏, 陈皓. 肝脏手术中肝血流阻断与肝脏缺血-再灌注损伤. 中国实用外科杂志, 2007, 27(1): 53-57.
12.	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. 中华肝胆外科杂志, 2013, 19(5): 321-324.
13.	Su Y, Pan H, Guo Z, et al. Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats. Dig Dis Sci, 2015, 60(2): 414-419.
14.	张雪华, 冯家林, 吴俊余. 半肝血流阻断术在肝癌切除术患者中的应用效果. 临床合理用药杂志, 2019, 12(18): 117-118.
15.	张贯启, 张志伟, 项帅, 等. 大肝癌手术切除术中不同肝血流阻断方法的临床研究. 中国普通外科杂志, 2015, 24(1): 18-22.
16.	杜锡林, 杨涛, 陈安, 等. 肝血流阻断技术在肝切除术中的应用评述. 西部医学, 2015, 27(7): 961-963, 970.
17.	Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
18.	姚磊, 王志明, 欧阳锡武, 等. 不同入肝血流阻断技术在原发性肝细胞癌肝切除术中的应用效果比较. 中国普通外科杂志, 2019, 28(7): 815-824.
19.	杨禄坤, 范东毅, 孔凡根, 等. 低中心静脉压技术在肝硬化患者腹腔镜肝切除术中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(2): 139-142.
20.	祁军安, 江奎, 朱海林, 等. 可控性低中心静脉压技术在肝切除术中的临床应用. 肝胆胰外科杂志, 2010, 22(4): 298-299, 302.
21.	梁力建, 王卫东, 黄雄庆, 等. 低中心静脉压减少肝切除术中出血的临床研究. 中国实用外科杂志, 2005, 25(12): 723-726.
22.	李尧, 张宝, 麻勇. 肝脏缺血再灌注损伤的研究进展. 国际外科学杂志, 2017, 44(4): 277-280.
23.	中国研究型医院学会肝胆胰外科专业委员会. 肝硬化患者肝切除术后肝功能不全的预防与治疗专家共识(2019 版). 中华消化外科杂志, 2019, 18(4): 297-302.
24.	段卫星. 原发性肝细胞癌切除术后肝功能不全 60 例的临床分析. 肝胆外科杂志, 2017, 25(4): 295-297.
25.	Huang Z, Zhang P, Wang H, et al. Comparing outcomes of two vascular inflow occlusion techniques and treatment without vascular occlusion during major hepatectomy in patients with hepatitis B-related hepatocellular carcinoma. PLoS One, 2014, 9(9): e107303.
26.	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. Am J Surg, 2011, 201(1): 62-69.

1. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019 年版). 肿瘤综合治疗电子杂志, 2020, 6(2): 55-85.
2. 张业繁, 蔡建强. 2018《CSCO 原发性肝癌诊疗指南》解读—外科部分. 肝癌电子杂志, 2018, 5(3): 1-3.
3. Pringle JH. Ⅴ. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
4. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet, 1987, 164(2): 155-158.
5. 杨广超, 刘连新. 肝癌肝切除术中血流控制方式选择和评价. 中国实用外科杂志, 2018, 38(4): 383-387.
6. 文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展. 中国普外基础与临床杂志, 2008, 15(4): 299-302.
7. 王亚运, 胡欢, 王世垚, 等. 肝血流阻断技术在肝切除术中的应用. 西北国防医学杂志, 2020, 41(1): 58-63.
8. Chikamoto A, Beppu T, Masuda T, et al. Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma. Hepatogastroenterology, 2012, 59(116): 1213-1216.
9. Tong Y, Yang JM, Lai EC, et al. Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection: a comparative study. Hepatogastroenterology, 2011, 58(109): 1307-1311.
10. 张业繁, 陈晓, 李智宇, 等. 术中出血 400 mL 以上是 BCLC B 期肝癌患者预后不良的独立危险因素. 癌症进展, 2017, 15(3): 308-311.
11. 彭承宏, 陈皓. 肝脏手术中肝血流阻断与肝脏缺血-再灌注损伤. 中国实用外科杂志, 2007, 27(1): 53-57.
12. 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. 中华肝胆外科杂志, 2013, 19(5): 321-324.
13. Su Y, Pan H, Guo Z, et al. Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats. Dig Dis Sci, 2015, 60(2): 414-419.
14. 张雪华, 冯家林, 吴俊余. 半肝血流阻断术在肝癌切除术患者中的应用效果. 临床合理用药杂志, 2019, 12(18): 117-118.
15. 张贯启, 张志伟, 项帅, 等. 大肝癌手术切除术中不同肝血流阻断方法的临床研究. 中国普通外科杂志, 2015, 24(1): 18-22.
16. 杜锡林, 杨涛, 陈安, 等. 肝血流阻断技术在肝切除术中的应用评述. 西部医学, 2015, 27(7): 961-963, 970.
17. Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
18. 姚磊, 王志明, 欧阳锡武, 等. 不同入肝血流阻断技术在原发性肝细胞癌肝切除术中的应用效果比较. 中国普通外科杂志, 2019, 28(7): 815-824.
19. 杨禄坤, 范东毅, 孔凡根, 等. 低中心静脉压技术在肝硬化患者腹腔镜肝切除术中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(2): 139-142.
20. 祁军安, 江奎, 朱海林, 等. 可控性低中心静脉压技术在肝切除术中的临床应用. 肝胆胰外科杂志, 2010, 22(4): 298-299, 302.
21. 梁力建, 王卫东, 黄雄庆, 等. 低中心静脉压减少肝切除术中出血的临床研究. 中国实用外科杂志, 2005, 25(12): 723-726.
22. 李尧, 张宝, 麻勇. 肝脏缺血再灌注损伤的研究进展. 国际外科学杂志, 2017, 44(4): 277-280.
23. 中国研究型医院学会肝胆胰外科专业委员会. 肝硬化患者肝切除术后肝功能不全的预防与治疗专家共识(2019 版). 中华消化外科杂志, 2019, 18(4): 297-302.
24. 段卫星. 原发性肝细胞癌切除术后肝功能不全 60 例的临床分析. 肝胆外科杂志, 2017, 25(4): 295-297.
25. Huang Z, Zhang P, Wang H, et al. Comparing outcomes of two vascular inflow occlusion techniques and treatment without vascular occlusion during major hepatectomy in patients with hepatitis B-related hepatocellular carcinoma. PLoS One, 2014, 9(9): e107303.
26. 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. Am J Surg, 2011, 201(1): 62-69.

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Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma

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