Comparison of using infrahepatic inferior vena cava clamping versus controlled low central venous pressure in complex hepatectomy
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肝切除术;止血技术;中心静脉压;腔静脉,下

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    Abstract:

    Objective: To compare the safety and efficacy of using infrahepatic inferior vena cava (IIVC) clamping and controlled low central venous pressure (CLCVP) technique in complex hepatectomy. Methods: The clinical data of 103 patients with hepatocellular carcinoma undergoing complex hepatectomy between March 2016 and December 2017 were retrospectively analyzed. Pringle maneuver was used for hepatic inflow control in all patients, of whom, 56 cases underwent IIVC clamping (IIVC clamping group) and 47 cases underwent CLCVP (CLCVP group) for reducing the central venous pressure (CVP). The changes of CVP and blood loss during parenchymal transection, total intraoperative blood loss, intraoperative urine volume, rate of blood transfusion and incidence of postoperative complications, as well as postoperative liver and renal functions between the two groups of patients were compared. Results: The general data showed no significant differences between the two groups of patients (all P>0.05). The CVP levels in both groups were decreased significantly during parenchymal transection, but the decreasing amplitude in IIVC clamping group was greater than that in CLCVP group, and blood loss during parenchymal transection, the total intraoperative blood loss, ALT level on postoperative day (POD) 3 and TBIL level on POD 3 and 7 in IIVC clamping group were significantly lower than those in CLCVP group (all P<0.05). There were no significant differences in intraoperative urine volume, blood transfusion rate, incidence of postoperative complications and renal function parameters between the two groups (all P>0.05). Conclusion: The operation of IIVC clamping combined with Pringle maneuver is simple and convenient, and it has advantages of less influence on systemic hemodynamics, faster recovery of liver function and easier CVP reduction for controlling bleeding in the cutting surface of the liver compared with CLCVP. So this method is helpful for improving the safety of complex hepatectomy.

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YAO Yutong, HUANG Xiaolun, LUO Lanyun, XUE Hua, LUO Le, XIANG Guangming, Lai Chu. Comparison of using infrahepatic inferior vena cava clamping versus controlled low central venous pressure in complex hepatectomy[J]. Chin J Gen Surg,2018,27(7):880-885.
DOI:10.7659/j. issn.1005-6947.2018.07.012

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History
  • Received:May 22,2018
  • Revised:May 22,2018
  • Adopted:
  • Online: July 15,2018
  • Published: