Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 DINGHe-yi , TAIQin-wen , ZHOUCheng-ming , YUBing-bing , WENHao ,  ZHANGJin-hui

The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ZHANGJin-hui, Email: zhangjinhui2001@sina.cn

Keywords：

Hepatectomy; Hemihepatic vascular occlusion; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140081

Video：

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Objective To assess the effectiveness of hemihepatic vascular occlusion (HHO) and total hepatic inflow occlusion (THO) which were applied in the liver resection. Methods Randomized controlled trials (RCTs) comparing HHO and THO in hepatectomy were electro-nically searched from CENTRAL (Issue 1, 2013), PubMed, EMbase, CBM, CNKI and Digital Journals of Chinese Medical System. The English or Chinese version of relevant published and unpublished data and their references were also retrieved by hand. The last retrieval date was in May 2013. The data were extracted and the quality was evaluated by two reviewers independently, and then RevMan 5.2 software was used for data analysis. Results Ten RCTs involving 788 patients were finally included. The results of meta-analysis showed that, HHO reduced the levels of aspartate transaminase (AST) (WMD=-235.84, 95%CI-411.28 to-60.40, P=0.008) and alanine aminotransferase (ALT) (WMD=-195.52, 95%CI-351.87 to-39.16, P=0.01) in 1 day postoperatively. HHO also shortened the recovery time of AST (WMD=-3.83, 95%CI-4.52 to-3.15, P < 0.000 01) and ALT (WMD=-4.29, 95%CI-5.75 to-2.84, P < 0.000 01) postoperatively, and shortened the recovery time of gastrointestinal function (WMD=-1.52, 95%CI-2.75 to-0.29, P=0.02). However, HHO was the same as THO in intraoperative haemorrhage and postoperative transfusion and hospital stay. Conclusion HHO applied in liver resection could relieve the damage of liver function, and shorten the recovery time of gastrointestinal function postoperatively. Due to the poor quality of the included studies, more high quality RCTs with longer follow-up are required to further verify the aforementioned conclusion.

Citation： DINGHe-yi, TAIQin-wen, ZHOUCheng-ming, YUBing-bing, WENHao, ZHANGJin-hui. Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(4): 469-477. doi: 10.7507/1672-2531.20140081 Copy

1.	Belghiti J, Kabbej M, Sauvanet A, et al.Drainage after elective hepatic resection:A randomized trial.Ann Surg, 1993, 218(6):748-753.
2.	Shimada M, Takenaka K, Fujiwara Y, et al.Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.Br J Surg, 1998, 85(2):195-198.
3.	Ibrahim S, Chen CL, Lin CC, et al.Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.Liver Transpl, 2006, 12(6):950-957.
4.	Yoshimura Y, Kubo S, Shirata K, et al.Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma.World J Surg, 2004, 28(10):982-986.
5.	Pringle JH.Notes on the arrest of hepatie hemorrhage due to trauma.Ann Surg, 1908, 48(4):541-549.
6.	Makuuchi M, Mori T, Gunven P, et al.Safety of hemihepatic vascular occlusion during of the liver.Surg Gynecol Obstet, 1987, 164(2):155-158.
7.	Higgins J, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration, 2011.Available at:www.cochrane-handbook.org.
8.	Figueras J, Llado L, Ruiz D, et al.Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial.Ann Surg, 2005, 241(4):582-590.
9.	Liang G, Wen T, Yan L, et al.A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.Hepatogastroenterology, 2009, 56(91-92):745-750.
10.	Si-Yuan FU, Yee LW, Guang-Gang L, 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.
11.	Wu CC, Yeh DC, Ho WM, et al.Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques.Arch Surg, 2002, 137(12):1369-1376.
12.	张忠宝, 关中正, 王亮.半肝血流阻断法用于肝切除术效果观察.山东医药, 2011, 51(35):57-58.
13.	张玉惠, 张伟忠, 梁金荣.肝叶切除中两种肝血流阻断方式的临床疗效比较.中国基层医药, 2011, 18(24):3390-3391.
14.	秦凯, 聂双发.半肝血流阻断在肝癌手术切除中的应用研究.贵阳医学院学报, 2010, 35(6):581-582.
15.	黄颖峰, 唐伟镖, 杨劭宇.半肝血供阻断术和Pringle术对肝硬化肿瘤患者肝功能的影响.现代医学, 2006, 6(8):20-21.
16.	刘力, 张颖, 郑向奎, 等.半肝与全肝人肝血流阻断法肝切除术的临床观察:附56例报告.中国普通外科杂志, 2008, 17(7):727-728.
17.	罗毅, 秦红军, 罗伟.半肝和全肝人肝血流阻断技术在肝切除术中的应用比较.中国医师进修杂志, 2011, 34(23):36-37.
18.	Nakai T, Koh K, Funai S, et al.Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection.Am Coll Surg, 1999, 189(3):300-304.
19.	陈炜, 孙勇伟, 吴志勇.半肝血流阻断在肝硬化肝癌半肝切除术中的意义.肝胆外科杂志, 2005, 13(4):260-262.
20.	梁冠林, 陈哲宇, 文天夫.常温下连续阻断半肝血流60min在乙肝肝硬变患者肝切除术中的应用.中国普外基础与临床杂志, 2008, 7(15):503-507.
21.	Yin XY, Lai PB, Lee JF, et al.Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis.Br J Surg, 2000, 87(11):1510-1515.
22.	吴志科.半肝血流阻断在原发性肝癌肝脏部分切除术中的应用观察.中国当代医学, 2011, 18(34):31-32.
23.	李诤.选择性半肝血流阻断和Pringle's法对肝切除术后患者肝功能的影响.医药前沿, 2012, (36):191-192.
24.	周飞国, 刘才峰, 黄亮, 等.多处肝切除治疗复杂肝胆管结石病的并发症分析及防治.肝胆胰外科杂志, 2009, 21(2):110-114.
25.	卢军华, 杨田, 杨广顺, 等.右半肝切除治疗右侧及双侧肝内胆管结石.第二军医大学学报, 2008, 29(6):609-614.
26.	Yeh DC, Wu CC, Ho WM, et al.Bacterial translocation after cirrhotic liver resection:a clinical investigation of 181 patients.Surg Res, 2003, 111(2):209-214.

1. Belghiti J, Kabbej M, Sauvanet A, et al.Drainage after elective hepatic resection:A randomized trial.Ann Surg, 1993, 218(6):748-753.
2. Shimada M, Takenaka K, Fujiwara Y, et al.Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.Br J Surg, 1998, 85(2):195-198.
3. Ibrahim S, Chen CL, Lin CC, et al.Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.Liver Transpl, 2006, 12(6):950-957.
4. Yoshimura Y, Kubo S, Shirata K, et al.Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma.World J Surg, 2004, 28(10):982-986.
5. Pringle JH.Notes on the arrest of hepatie hemorrhage due to trauma.Ann Surg, 1908, 48(4):541-549.
6. Makuuchi M, Mori T, Gunven P, et al.Safety of hemihepatic vascular occlusion during of the liver.Surg Gynecol Obstet, 1987, 164(2):155-158.
7. Higgins J, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration, 2011.Available at:www.cochrane-handbook.org.
8. Figueras J, Llado L, Ruiz D, et al.Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial.Ann Surg, 2005, 241(4):582-590.
9. Liang G, Wen T, Yan L, et al.A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.Hepatogastroenterology, 2009, 56(91-92):745-750.
10. Si-Yuan FU, Yee LW, Guang-Gang L, 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.
11. Wu CC, Yeh DC, Ho WM, et al.Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques.Arch Surg, 2002, 137(12):1369-1376.
12. 张忠宝, 关中正, 王亮.半肝血流阻断法用于肝切除术效果观察.山东医药, 2011, 51(35):57-58.
13. 张玉惠, 张伟忠, 梁金荣.肝叶切除中两种肝血流阻断方式的临床疗效比较.中国基层医药, 2011, 18(24):3390-3391.
14. 秦凯, 聂双发.半肝血流阻断在肝癌手术切除中的应用研究.贵阳医学院学报, 2010, 35(6):581-582.
15. 黄颖峰, 唐伟镖, 杨劭宇.半肝血供阻断术和Pringle术对肝硬化肿瘤患者肝功能的影响.现代医学, 2006, 6(8):20-21.
16. 刘力, 张颖, 郑向奎, 等.半肝与全肝人肝血流阻断法肝切除术的临床观察:附56例报告.中国普通外科杂志, 2008, 17(7):727-728.
17. 罗毅, 秦红军, 罗伟.半肝和全肝人肝血流阻断技术在肝切除术中的应用比较.中国医师进修杂志, 2011, 34(23):36-37.
18. Nakai T, Koh K, Funai S, et al.Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection.Am Coll Surg, 1999, 189(3):300-304.
19. 陈炜, 孙勇伟, 吴志勇.半肝血流阻断在肝硬化肝癌半肝切除术中的意义.肝胆外科杂志, 2005, 13(4):260-262.
20. 梁冠林, 陈哲宇, 文天夫.常温下连续阻断半肝血流60min在乙肝肝硬变患者肝切除术中的应用.中国普外基础与临床杂志, 2008, 7(15):503-507.
21. Yin XY, Lai PB, Lee JF, et al.Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis.Br J Surg, 2000, 87(11):1510-1515.
22. 吴志科.半肝血流阻断在原发性肝癌肝脏部分切除术中的应用观察.中国当代医学, 2011, 18(34):31-32.
23. 李诤.选择性半肝血流阻断和Pringle's法对肝切除术后患者肝功能的影响.医药前沿, 2012, (36):191-192.
24. 周飞国, 刘才峰, 黄亮, 等.多处肝切除治疗复杂肝胆管结石病的并发症分析及防治.肝胆胰外科杂志, 2009, 21(2):110-114.
25. 卢军华, 杨田, 杨广顺, 等.右半肝切除治疗右侧及双侧肝内胆管结石.第二军医大学学报, 2008, 29(6):609-614.
26. Yeh DC, Wu CC, Ho WM, et al.Bacterial translocation after cirrhotic liver resection:a clinical investigation of 181 patients.Surg Res, 2003, 111(2):209-214.

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Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis

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