- Department of General S urgery and Center of L i ver T rans plantation , West China Hos pi tal , S ichuan Uni versi t y , Cheng du 610041 , China;
【Abstract】 Objective To review the advances in techniques of hepatic blood occlusion in hepatectomy. Methods The related literatures were reviewed and analysed. Results There were many techniques of hepatic blood occlusion. The most frequently used and studied techniques were hemihepatic vascular occlusion and intermittent hepatic inflow occlusion. Hepatic vascular exclusion was employed when hepatic veins and/or vena cava would be damaged. Total vascular exclusion and other techniques were rarely used. Conclusion To reduce blood loss in hepatectomy and make patient safe, based on the situation of the patient, the technique should be ingeniously selected.
Citation： W EN Tianf u,YA N Lnan. Advances in Techniques of Hepatic Blood Occlusion in Hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(4): 299-302. doi: Copy
Copyright ? the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. | Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185. |
| 2. | Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41. |
| 3. | Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques [J]. Arch Surg, 2002; 137(12)∶1369. |
| 4. | 蒲青凡, 嚴律南, 孫碎康, 等. 圍手術期輸血與肝臟術后感染并發癥的關系 [J]. 中國普外基礎與臨床雜志, 2003; 10(2)∶144. |
| 5. | Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63. |
| 6. | Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541. |
| 7. | Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704. |
| 8. | Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533. |
| 9. | Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794. |
| 10. | 涂兵, 嚴律南, 劉智敏. 缺血預處理對大鼠移植肝臟缺血再灌注損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2002; 9(2)∶89. |
| 11. | Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843. |
| 12. | Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480. |
| 13. | Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161. |
| 14. | Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454. |
| 15. | 陳孝平， 吳在德， 葉啟發， 等. 常溫下阻斷入肝血流行肝切除術81例臨床觀察 [J]. 中華外科雜志，1991; 29(2)∶84. |
| 16. | Belghiti J, Noun R, Malafosse R, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study [J]. Ann Surg, 1999; 229(3)∶369. |
| 17. | Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833. |
| 18. | Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169. |
| 19. | Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058. |
| 20. | Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949. |
| 21. | Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155. |
| 22. | 鄭光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途徑 [J]. 中國實用外科雜志，1989; 9（11）∶595. |
| 23. | 鄭光琪. 肝門區域血管阻斷切除肝臟腫瘤63例報告 [J]. 華西醫科大學學報，1992; 23（4）∶424. |
| 24. | 鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區域血管的肝段切除術133例報告 [J]. 肝膽外科雜志, 1995; 32（3）∶162. |
| 25. | 嚴律南， 袁朝新， 張肇達， 等. 應用半肝血流阻斷行肝葉切除術29例報告 [J]. 中華外科雜志，1994; 32（1）∶35. |
| 26. | Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376. |
| 27. | Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482. |
| 28. | Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265. |
| 29. | Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582. |
| 30. | Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20. |
| 31. | Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237. |
| 32. | 賴佳明, 梁力建, 黎東明. 肝血流阻斷在原發性肝癌切除術中的應用 [J]. 中國普外基礎與臨床雜志, 1999; 6(4)∶213. |
| 33. | 吳孟超， 仲劍平， 張曉華， 等. 常溫下全肝血流阻斷的肝切除術 [J]. 中華外科雜志, 1981; 19(1)∶36. |
| 34. | Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689. |
| 35. | Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155. |
| 36. | Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276. |
| 37. | 嚴律南， 盧實春， 陳曉理， 等. 用生物泵行體外靜脈轉流下的肝切除術 [J]. 中華肝膽外科雜志，2000; 6（1）∶37. |
| 38. | Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535. |
| 39. | Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176. |
| 40. | 文天夫, 嚴律南, 李波, 等. 活體右半肝供體的安全性 [J]. 中華外科雜志, 2006; 44(3)∶149. |
| 41. | Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644. |
| 42. | 黃潔夫， 劉唐彬. 改進的肝臟原位低溫灌注無血切肝術 [J]. 中華外科雜志，1994; 32（1）∶28. |
| 43. | Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167. |
- 1. Dimick JB, Cowan JA Jr, Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database [J]. Arch Surg, 2003; 138(2)∶185.
- 2. Dimick JB, Pronovost PJ, Cowan JA Jr, et al. Postoperative complication rates after hepatic resection in Maryland hospitals [J]. Arch Surg, 2003; 138(1)∶41.
- 3. Wu CC, Yeh DC, Ho WM, et al. Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques [J]. Arch Surg, 2002; 137(12)∶1369.
- 4. 蒲青凡, 嚴律南, 孫碎康, 等. 圍手術期輸血與肝臟術后感染并發癥的關系 [J]. 中國普外基礎與臨床雜志, 2003; 10(2)∶144.
- 5. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years [J]. Ann Surg, 2001; 234(1)∶63.
- 6. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma [J]. Ann Surg, 1908; 48(4)∶541.
- 7. Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study [J]. Ann Surg, 1997; 226(6)∶704.
- 8. Man K, Fan ST, Ng IO, et al. Tolerance of the liver to intermittent Pringle maneuver in hepatectomy for liver tumors [J]. Arch Surg, 1999; 134(5)∶533.
- 9. Kang KJ, Jang JH, Lim TJ, et al. Optimal cycle of intermittent portal triad clamping during liver resection in the murine liver [J]. Liver Transpl, 2004; 10(6)∶794.
- 10. 涂兵, 嚴律南, 劉智敏. 缺血預處理對大鼠移植肝臟缺血再灌注損傷的保護作用 [J]. 中國普外基礎與臨床雜志, 2002; 9(2)∶89.
- 11. Clavien PA, Selzner M, Rüdiger HA, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning [J]. Ann Surg, 2003; 238(6)∶843.
- 12. Carini R, Albano E. Recent insights on the mechanisms of liver preconditioning [J]. Gastroenterology, 2003; 125(5)∶1480.
- 13. Hannoun L, Borie D, Delva E, et al. Liver resection with normothermic ischaemia exceeding 1 h [J]. Br J Surg, 1993; 80(9)∶1161.
- 14. Huguet C, Gavelli A, Bona S. Hepatic resection with ischemia of the liver exceeding one hour [J]. J Am Coll Surg, 1994; 178(5)∶454.
- 15. 陳孝平， 吳在德， 葉啟發， 等. 常溫下阻斷入肝血流行肝切除術81例臨床觀察 [J]. 中華外科雜志，1991; 29(2)∶84.
- 16. Belghiti J, Noun R, Malafosse R, et al. Continuous versus intermittent portal triad clamping for liver resection: a controlled study [J]. Ann Surg, 1999; 229(3)∶369.
- 17. Hardy KJ, Tancheroen S, Shulkes A. Comparison of continuous versus intermittent ischaemia-reperfusion during liver resection in an experimental model [J]. Br J Surg, 1995; 82(6)∶833.
- 18. Kim YI, Ishii T, Aramaki M, et al. The Pringle maneuver induces only partial ischemia of the liver [J]. Hepatogastroenterology, 1995; 42(2)∶169.
- 19. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [J]. Br J Surg, 1998; 85(8)∶1058.
- 20. Smyrniotis V, Kostopanagiotou G, Lolis E, et al. Effects of hepatovenous back flow on ischemic-reperfusion injuries in liver resections with the Pringle maneuver [J]. J Am Coll Surg, 2003; 197(6)∶949.
- 21. Makuuchi M, Mori T, Gunvén P, et al. Safety of hemihepatic vascular occlusion during resection of the liver [J]. Surg Gynecol Obstet, 1987; 164(2)∶155.
- 22. 鄭光琪， 何生， 文天夫， 等. 提高大肝癌切除的安全性的途徑 [J]. 中國實用外科雜志，1989; 9（11）∶595.
- 23. 鄭光琪. 肝門區域血管阻斷切除肝臟腫瘤63例報告 [J]. 華西醫科大學學報，1992; 23（4）∶424.
- 24. 鄭光琪， 文天夫， 胡偉明， 等. 阻斷肝門區域血管的肝段切除術133例報告 [J]. 肝膽外科雜志, 1995; 32（3）∶162.
- 25. 嚴律南， 袁朝新， 張肇達， 等. 應用半肝血流阻斷行肝葉切除術29例報告 [J]. 中華外科雜志，1994; 32（1）∶35.
- 26. Takayama T, Makuuchi M, Inoue K, et al. Selective and unselective clamping in cirrhotic liver [J]. Hepatogastroenterology, 1998; 45(20)∶376.
- 27. Malassagne B, Cherqui D, Alon R, et al. Safety of selective vascular clamping for major hepatectomies [J]. J Am Coll Surg, 1998; 187(5)∶482.
- 28. Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the half-Pringle [J]. Am J Surg, 2001; 182(3)∶265.
- 29. Figueras J, Llado L, Ruiz D, et al. Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial [J]. Ann Surg, 2005; 241(4)∶582.
- 30. Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion [J]. Ann Surg, 1989; 210(1)∶20.
- 31. Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports [J]. Ann Surg, 1966; 163(2)∶237.
- 32. 賴佳明, 梁力建, 黎東明. 肝血流阻斷在原發性肝癌切除術中的應用 [J]. 中國普外基礎與臨床雜志, 1999; 6(4)∶213.
- 33. 吳孟超， 仲劍平， 張曉華， 等. 常溫下全肝血流阻斷的肝切除術 [J]. 中華外科雜志, 1981; 19(1)∶36.
- 34. Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy [J]. Surg Gynecol Obstet, 1978; 147(5)∶689.
- 35. Belghiti J, Noun R, Zante E, et al. Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study [J]. Ann Surg, 1996; 224(2)∶155.
- 36. Yamaoka Y, Ozawa K, Kumada K, et al. Total vascular exclusion for hepatic resection in cirrhotic patients. Application of venovenous bypass [J]. Arch Surg, 1992; 127(3)∶276.
- 37. 嚴律南， 盧實春， 陳曉理， 等. 用生物泵行體外靜脈轉流下的肝切除術 [J]. 中華肝膽外科雜志，2000; 6（1）∶37.
- 38. Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy [J]. Br J Surg, 1995; 82(11)∶1535.
- 39. Makuuchi M, Yamamoto J, Takayama T, et al. Extrahepatic division of the right hepatic vein in hepatectomy [J]. Hepatogastroenterology, 1991; 38(2)∶176.
- 40. 文天夫, 嚴律南, 李波, 等. 活體右半肝供體的安全性 [J]. 中華外科雜志, 2006; 44(3)∶149.
- 41. Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion [J]. Ann Surg, 1974; 180(4)∶644.
- 42. 黃潔夫， 劉唐彬. 改進的肝臟原位低溫灌注無血切肝術 [J]. 中華外科雜志，1994; 32（1）∶28.
- 43. Torzilli G, Makuuchi M, Midorikawa Y, et al. Liver resection without total vascular exclusion: hazardous or beneficial? An analysis of our experience [ J ] . Ann Surg, 2001; 233(2) ∶ 167.