Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma

AIM:To investigate the clinical significance of hepatic blood inflow occlusion without hemihepatic artery control (BIOwHAC) in the treatment of hepatocellular carcinoma (HCC).METHODS:Fifty-nine patients with HCC were divided into 3 groups based on the technique used for achieving hepatic vascular occlusion:group 1,vascular occlusion was achieved by the Pringle maneuver (n=20);group 2,by hemihepatic vascular occlusion (HVO) (n=20);and group 3,by BIOwHAC (n=19).We compared the procedures among the three groups in term of operation time,intraoperative bleeding,postoperative liver function,postoperative complications,and length of hospital stay.RESULTS:There were no statistically significant differences (P > 0.05) in age,sex,pathological diagnosis,preoperative Child's disease grade,hepatic function,and tumor size among the three groups.No intraoperative complications or deaths occurrred,and there were no significant intergroup differences (P > 0.05) in intraoperative bleeding,hepatic function change 3 and 7 d after operation,the incidence of complications,and length of hospital stay.BIOwHAC and Pringle maneuver required a significantly shorter operation time than HVO;the difference in the serum alanine aminotransferase or aspartate aminotransferase levels before and 1 d after operation was more significant in the BIOwHAC and HVO groups than in the Pringle maneuver group (P < 0.05).CONCLUSION:BIOwHAC is convenient and safe;this technique causes slight hepatic ischemia-reperfusion injury similar to HVO.

Hepatic blood inflow occlusion with/without hemihepatic artery control versus the Pringle maneuver in resection of hepatocellular carcinoma： a retrospective comparative analysis

Background The Pringle maneuver, which has been the standard for hepatic resection surgery for a long time, has the major flaw of ischemic damage in the liver. The aim of this research was to evaluate hepatic blood inflow occlusion with/without hemihepatic artery control vs. the Pringle maneuver in hepatocellular carcinoma （HCC） resection. Methods Two hundred and eighty-one cases of resection of HCC with hepatic blood inflow occlusion （with/without hemihepatic artery control） and the Pringle maneuver from January 2006 to December 2008 in our hospital were analyzed and compared retrospectively; among them 107 were in group I （Pringle maneuver）, 98 in group II （hepatic blood inflow occlusion）, and 76 in group III （hepatic blood inflow occlusion without hemihepatic artery control）. The operation time, intraoperative blood loss, postoperative liver function and complications were used as the endpoints for evaluation. Results The operative duration and intraoperative blood loss of three groups showed no significant difference; alanine aminotransferase, total bilirubin and incidence of postoperative complications were significantly lower in groups II and Ill postoperation than those in group I. Conclusion Hepatic blood inflow occlusion without hemihepatic artery control is safe, convenient and feasible for resection of HCC, especially for cases involving underlying diseases such as cirrhosis.

保留半肝动脉血供的入肝血流阻断法对大鼠肝缺血再灌注损伤的影响

目的:探讨保留半肝动脉血供的入肝血流阻断法对大鼠肝血缺再灌注损伤的影响.方法:将96只Wistar大鼠随机分为Pringle法Ⅰ组、半肝阻断Ⅱ组和保留半肝动脉血供的入肝血流阻断Ⅲ组.阻断肝血流30 min后,去血管夹恢复血流,分别于再灌注后1,2,6,24 h,抽血检测ALT和AST水平,然后取肝组织用于检测肝脏超氧化物歧化酶(SOD)及丙二醛(MDA)含量、肝脏病理学及肝细胞凋亡.结果:与Ⅰ组比较Ⅱ组和Ⅲ组再灌注后各时间点,ALT,AST,肝组织MDA含量及细胞凋亡率显著降低,肝组织SOD活力明显升高.Ⅲ组肝功改变、肝组织MDA含量、SOD活力及肝细胞凋亡率与Ⅱ组之间无显著差异(P>0.05).结论:保留半肝动脉血供的入肝血流阻断法对肝脏缺血再灌注损伤轻,效果好,操作简单,因而优于半肝血流阻断法.

肝切除术中肝血流控制技术研究进展

术中出血是影响肝切除术后患者预后的重要因素,肝脏血流控制技术是减少术中出血的有效方法。各种肝血流控制技术有着各自的优缺点和适应证,需要临床医师充分了解、熟练掌握并个体化应用。目前,外科医师对于肝脏血流阻断技术的认识在临床实践中不断加深,其方法及临床应用也在不断改进和发展。本文就半肝入肝血流阻断法、全肝血流控制技术、Glisson蒂横断术、门静脉球囊阻断术等肝脏血流控制技术进展加以综述。

保留半肝血流阻断法对肝癌模型大鼠抑瘤作用及肝功能的影响

目的观察保留半肝血流阻断法对肝癌模型大鼠抑瘤作用及肝功能的影响。方法30只健康大鼠随机分为Pringle完全阻断对照组、半肝阻断组、保留半肝血流阻断组各10只。采用门静脉注射H22肝癌移植瘤的方法建立肝癌大鼠模型，建模后3 d阻断大鼠入肝血流60 min后复流。5 d后，检测血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、白蛋白（ALB）含量与肝组织超氧化物歧化酶（SOD）、丙二醛（MDA）水平，计算肝细胞凋亡率与抑瘤率。结果半肝阻断组、保留半肝血流阻断组肝癌大鼠ALT、AST含量明显低于对照组，ALB含量明显高于对照组[（70.97±8.62）比（72.04±8.54）比（268.26±46.39） IU/L，（386.86±50.28）比（392.53±22.47）比（1109.24±279.35） IU/L，（29.54±2.16）比（28.63±2.27）比（25.29±2.13） g/L，t＝13.222、8.048、4.430、13.151、8.087、3.393，P＝0.001、0.008、0.018、0.000、0.008、0.024]；肝组织SOD明显高于对照组，MDA、肝细胞凋亡率明显低于对照组[（152.32±16.21）比（148.47±15.24）比（89.12±9.45） U/mg蛋白、（18.36±3.14）比（19.32±2.95）比（48.36±5.23） nmol/mg、（14.35±1.45）%比（15.12±1.54）%比（25.14±2.14）%，t＝10.651、15.552、13.200、10.466、15.294、12.018，P＝0.001、0.001、0.001、0.001、0.001、0.001]；肝阻断组、保留半肝血流阻断组瘤质量明显低于对照组[（1.83±0.32）比（1.90±0.35）比（2.62±0.41） g，t＝4.803，4.224，P＝0.008、0.018]；保留半肝血流阻断组与半肝阻断组ALT、AST、SOD、MDA、肝细胞凋亡率、大鼠瘤质量、抑瘤率比较差异均无统计学意义。结论保留半肝血流阻断法能减轻肝癌模型大鼠肝脏缺血再灌注损伤，增强抑瘤效果，且手术安全性高于半肝阻断法。