Table of Contents
HPB Surgery
Volume 9, Issue 3, Pages 188-189
http://dx.doi.org/10.1155/1996/84618

Techniques of Inflow Occlusion for Liver Resection

Centre Hospitalier & Universitaire de Rennes, Rue Henri le Guilloux, Rennes Cedex 35033, France

Copyright © 1996 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Limited resection can be a therapeutic approach in patients with cirrhosis with very low remnant hepatic function after resection. In this study, two hilar vascular clamping methods (hilar selective clamping [n=13] and hilar lobar clamping method [n=8]), which were used for resection ofhepatocellular carcinoma in patients with cirrhosis, were compared based on cardiovascular stability during clamping, intraoperative bleeding, operative time and postoperative course. In the past, the Pringle method had been used (n=19) and those instances were included for comparison. The mean operation time of the lobar clamping group was 209 ± 44 minutes, which was significantly less than that of the selective clamping group (259 ± 44 minutes, p < 0.05). Furthermore, the mean intraoperative blood loss of the lobar clamping group was 920 ± 400 milliliters, which was significantly less than that of the selective clamping group (1,640 ± 590 milliliters, p < 0.01). The postoperative total bilirubin and glutamine-oxaloacetic transaminase levels tended to be high in the Pringle group, but there was no significant difference between the groups. Although the blood pressure during clamping significantly decreased in all groups, the decrease was profound in the Pringle group as compared with those in the other two groups. Thus, as a method for controlling afferent bloodflow during hepatic resection in patients with cirrhosis, we recommend the lobar clamping method as a simple, safe and effective way to minimize bleeding and maintain cardiovascular stability.