Application of Hepatic Vascular Control in Laparoscopic Hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAN Yihe , LU Bangyu , CAI Xiaoyong , LU Wenqi , HUANG Yubin , JIN Xiaojian , LEI Yu , CHEN Yongjun

Department of Minimally Invasive Surgery,The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China;

Corresponding author：

Keywords：

Laparoscopy; Hepatectomy; Hepatic pedicle; Vascular control

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Objective 　To investigate the technique and feasibility of hepatic pedicle vascular control in laparoscopic hepatectomy.
Methods 　From May 2005 to June 2011, 95 cases of hepatectomies were performed by laparoscopy in the Department of Minimally Invasive Surgery, The First Affiliated Hospital, Guangxi Medical University.The characteristics of these cases were analyzed.
Results 　Left lateral segmentectomy were required in 21 patients, left hepatectomy in 13 patients, right hepatectomy in 4 patients, segmentectomy in 17 patients, tumor resection in 24 patients,hemangioma resection in 5 patients, and conversions to laparotomy in 11 patients. The intermittent Pringle maneuver were performed in 39 patients. The mean vascular clamping time in Pringle maneuver was （30.84±9.51） min. The selective vascular control of inflow were performed in 56 patients， the technique included intrahepatic Glisson approach in 14 patients and controlling hepatic artery and portal vein separately in 42 patients. Pre-parenchymal transection control of hepatic outflow were performed in 12 patients, included the left hepatic vein were controlled by suturing or separating in 11 patients and right hepatic vein was controlled by separating in 1 patient. Others were controlled intraparenchymally during transection. The mean operative time was （236.80±95.97） min，mean operative blood loss was（ 551.55±497.41） ml， concentrate red blood cells transfusion volume was（ 2.60±2.23） U， and plasma transfusion volume was （211.90±179.29） ml. The postoperative complications included bleeding in 4 patients, pleural effusion in 4 patients, pneumonia in 3 patients, ascites in 7 patients, and biliary fistula in 2 patients, and dead in 1 patient. The mean hospitalization time was（ 12.47±4.18） days. At the deadline（ February 2012）, 72 cases with liver cancer were followup. The follow-up time ranged from 5 to 81 months and the mean time was（ 24.14±16.62） months， where survival rate was 68.4%（ 54/79） of 1-year and 21.5%（ 17/79） of 3-year.
Conclusions 　The application of hepatic pedicle vascular control in laparoscopic hepatectomy is feasible.

Citation： YAN Yihe,LU Bangyu,CAI Xiaoyong,LU Wenqi,HUANG Yubin,JIN Xiaojian,LEI Yu,CHEN Yongjun,.. Application of Hepatic Vascular Control in Laparoscopic Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(7): 704-708. doi: Copy

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12.	Di Giuro G， Lainas P， Franco D， et al. Laparoscopic left hepatectomy with prior vascular control [J]. Surg Endosc， 2010，24(3)：697-699.
13.	晏益核，卢榜裕，蔡小勇，等. 门静脉意外损伤的腹腔镜修复 [J]. 中华普通外科杂志， 2011， 26(6)：514-515.
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15.	Machado MA， Surjan RC， Makdissi FF. Intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy [J]. Surg Endosc， 2011， 25(12)：3930-3933.
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18.	晏益核，卢榜裕，蔡小勇，等. 选择性出、入肝血流阻断技术在腹腔镜肝切除术中的应用 [J]. 中华外科杂志， 2010， 48(15)：1190-1191.
19.	Machado MA， Makdissi FF， Surjan RC， et al. Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach [J]. Surg Endosc， 2009， 23(11)：2615-2619.
20.	Cai XJ， Wang ZF， Yu H，et al. Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow [J]. Chin Med J (Engl)， 2008， 121(20)：2103-2106.
21.	蔡秀军，王一帆. 腹腔镜肝切除术中出血的控制 [J]. 中华外科杂志， 2010， 48(3)：171-172.
22.	许军. 腹腔镜在肝脏手术中的应用 [J/CD]. 中华腔镜外科杂志( 电子版)， 2010， 3(6)：488-492.
23.	Han HS， Yoon YS， Cho JY， et al. Laparoscopic right hemihepatectomy for hepatocellular carcinoma [J]. Ann Surg Oncol，2010， 17(8)：2090-2091.
24.	Pearce NW， Di Fabio F， Teng MJ， et al. Laparoscopic right hepatectomy：a challenging， but feasible， safe and efficient procedure [J]. Am J Surg， 2011， 202(5)：e52- e58.
25.	吴志明， Nathanson L， O’Rourke N. 腹腔镜规则性右半肝切除12 例临床分析 [J]. 中华普通外科杂志， 2006， 21(1)：16-18.

1. Belghiti J， Marty J， Farges O. Techniques， hemodynamic monitoring，and indications for vascular clamping during liver resections [J]. J Hepatobiliary Pancreat Surg， 1998， 5(1)：69-76.
2. Belghiti J， Noun R， Malafosse R， et al. Continuous versus intermittent portal triad clamping for liver resection：a controlled study [J]. Ann Surg， 1999， 229(3)：369-375.
3. Doi K， Horiuchi T， Uchinami M， et a1. Hepatic ischemia-reperfusion promotes liver metastasis of colon cancer [J]. J Surg Res，2002， 105(2)：243-247.
4. Ozaki M， Todo S. Surgical stress and tumor behavior：impact of ischemia reperfusion and hepatic resection on tumor progression [J]. Liver Transpl， 2007， 13(12)：1623-1626．.
5. Tung-Ping Poom R， Fan ST， Wong J. Risk factors，prevention，and management of postoperative recurrence after resection of hepatocellular carcinoma [J]. Ann Surg， 2000， 232(1)：10-24．.
6. Donadon M， Giacomoni A， Lauterio A， et al. Recurrence of hepato cellular carcinoma after liver transplantation presenting with massive intrahepatic bleeding [J]. Liver Transpl， 2008，14(2)：259-261.
7. 卢榜裕，陆文奇，蔡小勇，等. 腔镜下肝门血流阻断器在部分肝切除术中的应用 [J]. 中国内镜杂志， 2005， 11(9)：982-983.
8. 卢榜裕，陆文奇，蔡小勇，等. 腔镜下第一肝门血流阻断器在部分肝切术中的应用 [J]. 生物医学工程与临床， 2005， 9(2)：84-86.
9. 王宏光，张煊，董家鸿. 腹腔镜肝切除技术的优化 [J]. 中国普外基础与临床杂志， 2010， 17(6)：538-542.
10. 李建伟，郑树国，陈健，等. 选择性半肝血流阻断在腹腔镜肝切除术中的应用 [J]. 中国实用外科杂志， 2009， 29(12)：1025-1027.
11. 蔡柳新，方哲平，李剑锋，等. 选择性半肝血流阻断技术在腹腔镜肝切除术中的应用 [J]. 中华肝胆外科杂志， 2009， 15(4)：306-307.
12. Di Giuro G， Lainas P， Franco D， et al. Laparoscopic left hepatectomy with prior vascular control [J]. Surg Endosc， 2010，24(3)：697-699.
13. 晏益核，卢榜裕，蔡小勇，等. 门静脉意外损伤的腹腔镜修复 [J]. 中华普通外科杂志， 2011， 26(6)：514-515.
14. Machado MA， Makdissi FF， Herman P， et al. Intrahepatic Glissonian approach for pure laparoscopic left hemihepatectomy [J].J Laparoendosc Adv Surg Tech A， 2010， 20(2)：141-142.
15. Machado MA， Surjan RC， Makdissi FF. Intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy [J]. Surg Endosc， 2011， 25(12)：3930-3933.
16. Machado MA， Kalil AN. Glissonian approach for laparoscopic mesohepatectomy [J]. Surg Endosc， 2011， 25(6)：2020-2022.
17. Ikeda T， Yonemura Y， Ueda N， et al. Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding [J]. Surg Today， 2011， 41(12)：1592-1598.
18. 晏益核，卢榜裕，蔡小勇，等. 选择性出、入肝血流阻断技术在腹腔镜肝切除术中的应用 [J]. 中华外科杂志， 2010， 48(15)：1190-1191.
19. Machado MA， Makdissi FF， Surjan RC， et al. Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach [J]. Surg Endosc， 2009， 23(11)：2615-2619.
20. Cai XJ， Wang ZF， Yu H，et al. Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow [J]. Chin Med J (Engl)， 2008， 121(20)：2103-2106.
21. 蔡秀军，王一帆. 腹腔镜肝切除术中出血的控制 [J]. 中华外科杂志， 2010， 48(3)：171-172.
22. 许军. 腹腔镜在肝脏手术中的应用 [J/CD]. 中华腔镜外科杂志( 电子版)， 2010， 3(6)：488-492.
23. Han HS， Yoon YS， Cho JY， et al. Laparoscopic right hemihepatectomy for hepatocellular carcinoma [J]. Ann Surg Oncol，2010， 17(8)：2090-2091.
24. Pearce NW， Di Fabio F， Teng MJ， et al. Laparoscopic right hepatectomy：a challenging， but feasible， safe and efficient procedure [J]. Am J Surg， 2011， 202(5)：e52- e58.
25. 吴志明， Nathanson L， O’Rourke N. 腹腔镜规则性右半肝切除12 例临床分析 [J]. 中华普通外科杂志， 2006， 21(1)：16-18.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Hepatic Vascular Control in Laparoscopic Hepatectomy

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