- Department of General S urgery and Center of L i ver T rans plantation , West China Hos pi tal , S ichuan Uni versi t y , Cheng du 610041 , China;
【Abstract】 Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy. Methods The related literatures were reviewed and analysed. Results There were many techniques of hepatic blood occlusion. The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion. Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged. Total vascular exclusion and other techniques were rarely used. Conclusion To reduce blood loss in hepatectomy and make patient safe, based on the situation of the patient, the technique should be ingeniously selected.
Citation： W EN Tianf u,YA N Lnan. Advances in Techniques of Hepatic Blood Occlusion in Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(4): 299-302. doi: Copy
| 1. | Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185. |
| 2. | Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41. |
| 3. | 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 [J]. Arch Surg, 2002; 137(12)∶1369. |
| 4. | 蒲青凡, 严律南, 孙碎康, 等. 围手术期输血与肝脏术后感染并发症的关系 [J]. 中国普外基础与临床杂志, 2003; 10(2)∶144. |
| 5. | Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63. |
| 6. | Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541. |
| 7. | Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704. |
| 8. | Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533. |
| 9. | Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794. |
| 10. | 涂兵, 严律南, 刘智敏. 缺血预处理对大鼠移植肝脏缺血再灌注损伤的保护作用 [J]. 中国普外基础与临床杂志, 2002; 9(2)∶89. |
| 11. | Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843. |
| 12. | Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480. |
| 13. | Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161. |
| 14. | Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454. |
| 15. | 陈孝平， 吴在德， 叶启发， 等. 常温下阻断入肝血流行肝切除术81例临床观察 [J]. 中华外科杂志，1991; 29(2)∶84. |
| 16. | 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. |
| 17. | Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833. |
| 18. | Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169. |
| 19. | Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058. |
| 20. | Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949. |
| 21. | Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155. |
| 22. | 郑光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途径 [J]. 中国实用外科杂志，1989; 9（11）∶595. |
| 23. | 郑光琪. 肝门区域血管阻断切除肝脏肿瘤63例报告 [J]. 华西医科大学学报，1992; 23（4）∶424. |
| 24. | 郑光琪， 文天夫， 胡伟明， 等. 阻断肝门区域血管的肝段切除术133例报告 [J]. 肝胆外科杂志, 1995; 32（3）∶162. |
| 25. | 严律南， 袁朝新， 张肇达， 等. 应用半肝血流阻断行肝叶切除术29例报告 [J]. 中华外科杂志，1994; 32（1）∶35. |
| 26. | Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376. |
| 27. | Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482. |
| 28. | Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265. |
| 29. | Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582. |
| 30. | Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20. |
| 31. | Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237. |
| 32. | 赖佳明, 梁力建, 黎东明. 肝血流阻断在原发性肝癌切除术中的应用 [J]. 中国普外基础与临床杂志, 1999; 6(4)∶213. |
| 33. | 吴孟超， 仲剑平， 张晓华， 等. 常温下全肝血流阻断的肝切除术 [J]. 中华外科杂志, 1981; 19(1)∶36. |
| 34. | Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689. |
| 35. | Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155. |
| 36. | Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276. |
| 37. | 严律南， 卢实春， 陈晓理， 等. 用生物泵行体外静脉转流下的肝切除术 [J]. 中华肝胆外科杂志，2000; 6（1）∶37. |
| 38. | Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535. |
| 39. | Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176. |
| 40. | 文天夫, 严律南, 李波, 等. 活体右半肝供体的安全性 [J]. 中华外科杂志, 2006; 44(3)∶149. |
| 41. | Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644. |
| 42. | 黄洁夫， 刘唐彬. 改进的肝脏原位低温灌注无血切肝术 [J]. 中华外科杂志，1994; 32（1）∶28. |
| 43. | Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167. |
- 1. Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185.
- 2. Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41.
- 3. 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 [J]. Arch Surg, 2002; 137(12)∶1369.
- 4. 蒲青凡, 严律南, 孙碎康, 等. 围手术期输血与肝脏术后感染并发症的关系 [J]. 中国普外基础与临床杂志, 2003; 10(2)∶144.
- 5. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63.
- 6. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541.
- 7. Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704.
- 8. Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533.
- 9. Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794.
- 10. 涂兵, 严律南, 刘智敏. 缺血预处理对大鼠移植肝脏缺血再灌注损伤的保护作用 [J]. 中国普外基础与临床杂志, 2002; 9(2)∶89.
- 11. Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843.
- 12. Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480.
- 13. Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161.
- 14. Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454.
- 15. 陈孝平， 吴在德， 叶启发， 等. 常温下阻断入肝血流行肝切除术81例临床观察 [J]. 中华外科杂志，1991; 29(2)∶84.
- 16. 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.
- 17. Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833.
- 18. Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169.
- 19. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058.
- 20. Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949.
- 21. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155.
- 22. 郑光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途径 [J]. 中国实用外科杂志，1989; 9（11）∶595.
- 23. 郑光琪. 肝门区域血管阻断切除肝脏肿瘤63例报告 [J]. 华西医科大学学报，1992; 23（4）∶424.
- 24. 郑光琪， 文天夫， 胡伟明， 等. 阻断肝门区域血管的肝段切除术133例报告 [J]. 肝胆外科杂志, 1995; 32（3）∶162.
- 25. 严律南， 袁朝新， 张肇达， 等. 应用半肝血流阻断行肝叶切除术29例报告 [J]. 中华外科杂志，1994; 32（1）∶35.
- 26. Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376.
- 27. Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482.
- 28. Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265.
- 29. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582.
- 30. Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20.
- 31. Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237.
- 32. 赖佳明, 梁力建, 黎东明. 肝血流阻断在原发性肝癌切除术中的应用 [J]. 中国普外基础与临床杂志, 1999; 6(4)∶213.
- 33. 吴孟超， 仲剑平， 张晓华， 等. 常温下全肝血流阻断的肝切除术 [J]. 中华外科杂志, 1981; 19(1)∶36.
- 34. Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689.
- 35. Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155.
- 36. Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276.
- 37. 严律南， 卢实春， 陈晓理， 等. 用生物泵行体外静脉转流下的肝切除术 [J]. 中华肝胆外科杂志，2000; 6（1）∶37.
- 38. Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535.
- 39. Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176.
- 40. 文天夫, 严律南, 李波, 等. 活体右半肝供体的安全性 [J]. 中华外科杂志, 2006; 44(3)∶149.
- 41. Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644.
- 42. 黄洁夫， 刘唐彬. 改进的肝脏原位低温灌注无血切肝术 [J]. 中华外科杂志，1994; 32（1）∶28.
- 43. Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167.