Abstract:Objective:To evaluate the effect of application of pringle maneuver combined with hepatic veins occlusion in the process of hepatectomy.
Methods:The clinical data of 37 cases of tumours that involved the second portal hepatis and underwent liver resection were surveyed retrospectively.Pringle maneuver combined with hepatic veins occlusion was used during the resections.
Results:In this series,there were 27 cases of hepatocelluar carcinoma,2 cases of metastatic liver tumor, and 8 giant haemangioma. The average size of the tumors was 12.7cm(6cm to 35cm) in diameter.One main hepatic vein was invaded by tumor in 6 cases,2 main hepatic veins were invaded by tumor in 20 cases and 3 main hepatic veins were invaded in 11 cases.Among the 37 hepatectomies,extended right hepatectomy was performed in 11 patients,right hemihepatectomy in 5,middle lobe hepatectomy in 9，extended left hepatectomy in 5，resection of segment Ⅷ in 4 and caudate lobectomy in 3 cases.The mean occlusion time of the first porta hepatis was 29min(17min～48min)，and occlusion time of the hepatic veins was 21min（8min～32min）.The average blood loss was 950ml（200ml～4000ml）. Postoperative complications occurred on 18 occasions, and all recovered after treatment. There was no mortality in this series.
Conclusions:Pringle maneuver combined with hepatic veins occlusion for complicated hepatectomy is safe， and is effective to prevent dangerous bleeding and air embolism with less disturbance of systemic hemodynamics.