Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xiaohui , WEN Wu ,  WAN Renhua , SAN Renfeng , XIONG Yuanpeng , LUO Laihui , LIU Weiqi , SONG Shengjiang , DONG Xiaoyuan

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P. R. China;

Corresponding?author：

WAN Renhua, Email: wrh1966@163.com

Keywords：

hepatectomy; primary hepatocellular carcinoma; hepatic inflow occlusion; Pringle method

DOI：

10.7507/1007-9424.202009037

Video：

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Objective To compare the efficacy and safety of three different modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma.Methods The clinical data of 152 patients with primary hepatocellular carcinoma who underwent hepatectomy and postoperative pathology examination in our department in recent 3 years (2017–2020) were retrospectively analyzed. According to the modes of intraoperative hepatic blood flow occlusion, the patients were divided into three groups: intermittent Pringle method (IPM) group (41 cases), IPM was applied only; hemihepatic group (35 cases), hemihepatic blood flow blocking method was used only; and combined group (76 cases), combined hemihepatic blood flow blocking method and IPM. SPSS software was used to compare the differences of the three groups’ general data, intraoperative blood loss and postoperative liver function indexes. The changes of transaminase levels in the three groups were observed dynamically.Results Baseline data of the three groups were not statistically significant (P>0.05). There were no statistically significant differences in operative time, the number of resected liver segments, blood transfusion rate, incidence of complications, and postoperative length of stay among the three groups (all P>0.05). The intraoperative blood loss of the combined group and the IPM group were significantly less than that of the hemihepatic group (P<0.05). There was no difference in blood loss between the combined group and the IPM group (P>0.05). However, the blocking times in the combined group were significantly less than those in the IPM group (P<0.05). The transaminases in the three groups were close to the preoperative level on the fifth day after operation. Conclusions In hepatectomy of primary hepatocellular carcinoma, the three blocking modes are safe and effective. The combined application of hemihepatic blood flow blocking method and intermittent Pringle method can significantly reduce intraoperative blood loss, reduce the number of blocking, and do not aggravate the liver function injury.

Citation： LI Xiaohui, WEN Wu, WAN Renhua, SAN Renfeng, XIONG Yuanpeng, LUO Laihui, LIU Weiqi, SONG Shengjiang, DONG Xiaoyuan. Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 768-773. doi: 10.7507/1007-9424.202009037 Copy

1.	中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療規范(2019 年版). 腫瘤綜合治療電子雜志, 2020, 6(2): 55-85.
2.	張業繁, 蔡建強. 2018《CSCO 原發性肝癌診療指南》解讀—外科部分. 肝癌電子雜志, 2018, 5(3): 1-3.
3.	Pringle JH. Ⅴ. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
4.	Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet, 1987, 164(2): 155-158.
5.	楊廣超, 劉連新. 肝癌肝切除術中血流控制方式選擇和評價. 中國實用外科雜志, 2018, 38(4): 383-387.
6.	文天夫, 嚴律南. 肝切除術中肝臟血流阻斷技術的研究進展. 中國普外基礎與臨床雜志, 2008, 15(4): 299-302.
7.	王亞運, 胡歡, 王世垚, 等. 肝血流阻斷技術在肝切除術中的應用. 西北國防醫學雜志, 2020, 41(1): 58-63.
8.	Chikamoto A, Beppu T, Masuda T, et al. Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma. Hepatogastroenterology, 2012, 59(116): 1213-1216.
9.	Tong Y, Yang JM, Lai EC, et al. Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection: a comparative study. Hepatogastroenterology, 2011, 58(109): 1307-1311.
10.	張業繁, 陳曉, 李智宇, 等. 術中出血 400 mL 以上是 BCLC B 期肝癌患者預后不良的獨立危險因素. 癌癥進展, 2017, 15(3): 308-311.
11.	彭承宏, 陳皓. 肝臟手術中肝血流阻斷與肝臟缺血-再灌注損傷. 中國實用外科雜志, 2007, 27(1): 53-57.
12.	郝勝華, 楊湘武, 楊文龍, 等. 間歇性肝門阻斷是原發性肝癌術后早期肝內復發的一項危險因素. 中華肝膽外科雜志, 2013, 19(5): 321-324.
13.	Su Y, Pan H, Guo Z, et al. Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats. Dig Dis Sci, 2015, 60(2): 414-419.
14.	張雪華, 馮家林, 吳俊余. 半肝血流阻斷術在肝癌切除術患者中的應用效果. 臨床合理用藥雜志, 2019, 12(18): 117-118.
15.	張貫啟, 張志偉, 項帥, 等. 大肝癌手術切除術中不同肝血流阻斷方法的臨床研究. 中國普通外科雜志, 2015, 24(1): 18-22.
16.	杜錫林, 楊濤, 陳安, 等. 肝血流阻斷技術在肝切除術中的應用評述. 西部醫學, 2015, 27(7): 961-963, 970.
17.	Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
18.	姚磊, 王志明, 歐陽錫武, 等. 不同入肝血流阻斷技術在原發性肝細胞癌肝切除術中的應用效果比較. 中國普通外科雜志, 2019, 28(7): 815-824.
19.	楊祿坤, 范東毅, 孔凡根, 等. 低中心靜脈壓技術在肝硬化患者腹腔鏡肝切除術中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(2): 139-142.
20.	祁軍安, 江奎, 朱海林, 等. 可控性低中心靜脈壓技術在肝切除術中的臨床應用. 肝膽胰外科雜志, 2010, 22(4): 298-299, 302.
21.	梁力建, 王衛東, 黃雄慶, 等. 低中心靜脈壓減少肝切除術中出血的臨床研究. 中國實用外科雜志, 2005, 25(12): 723-726.
22.	李堯, 張寶, 麻勇. 肝臟缺血再灌注損傷的研究進展. 國際外科學雜志, 2017, 44(4): 277-280.
23.	中國研究型醫院學會肝膽胰外科專業委員會. 肝硬化患者肝切除術后肝功能不全的預防與治療專家共識(2019 版). 中華消化外科雜志, 2019, 18(4): 297-302.
24.	段衛星. 原發性肝細胞癌切除術后肝功能不全 60 例的臨床分析. 肝膽外科雜志, 2017, 25(4): 295-297.
25.	Huang Z, Zhang P, Wang H, et al. Comparing outcomes of two vascular inflow occlusion techniques and treatment without vascular occlusion during major hepatectomy in patients with hepatitis B-related hepatocellular carcinoma. PLoS One, 2014, 9(9): e107303.
26.	Fu SY, Lau WY, Li GG, 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.

1. 中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療規范(2019 年版). 腫瘤綜合治療電子雜志, 2020, 6(2): 55-85.
2. 張業繁, 蔡建強. 2018《CSCO 原發性肝癌診療指南》解讀—外科部分. 肝癌電子雜志, 2018, 5(3): 1-3.
3. Pringle JH. Ⅴ. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg, 1908, 48(4): 541-549.
4. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obstet, 1987, 164(2): 155-158.
5. 楊廣超, 劉連新. 肝癌肝切除術中血流控制方式選擇和評價. 中國實用外科雜志, 2018, 38(4): 383-387.
6. 文天夫, 嚴律南. 肝切除術中肝臟血流阻斷技術的研究進展. 中國普外基礎與臨床雜志, 2008, 15(4): 299-302.
7. 王亞運, 胡歡, 王世垚, 等. 肝血流阻斷技術在肝切除術中的應用. 西北國防醫學雜志, 2020, 41(1): 58-63.
8. Chikamoto A, Beppu T, Masuda T, et al. Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma. Hepatogastroenterology, 2012, 59(116): 1213-1216.
9. Tong Y, Yang JM, Lai EC, et al. Complete hemihepatic vascular exclusion versus pringle maneuver for liver resection: a comparative study. Hepatogastroenterology, 2011, 58(109): 1307-1311.
10. 張業繁, 陳曉, 李智宇, 等. 術中出血 400 mL 以上是 BCLC B 期肝癌患者預后不良的獨立危險因素. 癌癥進展, 2017, 15(3): 308-311.
11. 彭承宏, 陳皓. 肝臟手術中肝血流阻斷與肝臟缺血-再灌注損傷. 中國實用外科雜志, 2007, 27(1): 53-57.
12. 郝勝華, 楊湘武, 楊文龍, 等. 間歇性肝門阻斷是原發性肝癌術后早期肝內復發的一項危險因素. 中華肝膽外科雜志, 2013, 19(5): 321-324.
13. Su Y, Pan H, Guo Z, et al. Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats. Dig Dis Sci, 2015, 60(2): 414-419.
14. 張雪華, 馮家林, 吳俊余. 半肝血流阻斷術在肝癌切除術患者中的應用效果. 臨床合理用藥雜志, 2019, 12(18): 117-118.
15. 張貫啟, 張志偉, 項帥, 等. 大肝癌手術切除術中不同肝血流阻斷方法的臨床研究. 中國普通外科雜志, 2015, 24(1): 18-22.
16. 杜錫林, 楊濤, 陳安, 等. 肝血流阻斷技術在肝切除術中的應用評述. 西部醫學, 2015, 27(7): 961-963, 970.
17. Ni JS, Lau WY, Yang Y, et al. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg, 2013, 17(8): 1414-1421.
18. 姚磊, 王志明, 歐陽錫武, 等. 不同入肝血流阻斷技術在原發性肝細胞癌肝切除術中的應用效果比較. 中國普通外科雜志, 2019, 28(7): 815-824.
19. 楊祿坤, 范東毅, 孔凡根, 等. 低中心靜脈壓技術在肝硬化患者腹腔鏡肝切除術中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(2): 139-142.
20. 祁軍安, 江奎, 朱海林, 等. 可控性低中心靜脈壓技術在肝切除術中的臨床應用. 肝膽胰外科雜志, 2010, 22(4): 298-299, 302.
21. 梁力建, 王衛東, 黃雄慶, 等. 低中心靜脈壓減少肝切除術中出血的臨床研究. 中國實用外科雜志, 2005, 25(12): 723-726.
22. 李堯, 張寶, 麻勇. 肝臟缺血再灌注損傷的研究進展. 國際外科學雜志, 2017, 44(4): 277-280.
23. 中國研究型醫院學會肝膽胰外科專業委員會. 肝硬化患者肝切除術后肝功能不全的預防與治療專家共識(2019 版). 中華消化外科雜志, 2019, 18(4): 297-302.
24. 段衛星. 原發性肝細胞癌切除術后肝功能不全 60 例的臨床分析. 肝膽外科雜志, 2017, 25(4): 295-297.
25. Huang Z, Zhang P, Wang H, et al. Comparing outcomes of two vascular inflow occlusion techniques and treatment without vascular occlusion during major hepatectomy in patients with hepatitis B-related hepatocellular carcinoma. PLoS One, 2014, 9(9): e107303.
26. Fu SY, Lau WY, Li GG, 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.

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Comparison of three modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma

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