Evaluation of total hepatic vascular exclusion and pringle maneuver in liver resection.
OBJECTIVE
The effects of total hepatic vascular exclusion and Pringle maneuver on intraoperative course and postoperative recovery were retrospectively studied.


METHODS
Records of 42 patients who underwent a major hepatectomy and six who had a minor hepatectomy were reviewed. Patients with chronic liver disease or obstructive jaundice were excluded. Hepatic vascular exclusion was used in 5 patients who were at high risk for back flow bleeding from the hepatic veins. Pedicular clamping was used in the other 43 patients. Intergroup differences in intraoperative blood loss, postoperative liver function, the serum interleukin-6 concentrations, and clinical outcome were compared.


RESULTS
In four patients of the hepatic vascular exclusion group (n = 5), intraoperative blood loss was less than 2000 mL, and 6000 mL in the remaining patient. However the hepatic vascular exclusion group had longer hepatic ischemia time (45.2 +/- 10.3 min vs. 30.6 +/- 10.9 min), a greater blood loss (2304 +/- 2106 L vs. 913 +/- 1130 mL), a higher serum interleukin-6 concentration (347 +/- 320 pg/mL vs. 93 +/- 58 pg/mL), and a higher morbidity rate (80 vs. 7.1%) compared with the pedicular clamping group (n = 43) (P < 0.05). Postoperative liver function tests were comparable, and no patient developed postoperative hepatic failure. In the pedicular clamping group, intermittent pedicular clamping with periods of 15 minutes (n = 12) increased blood loss (662 +/- 421 mL vs. 1427 +/- 1890 mL), but did not reduce serum interleukin-6 concentration, liver cell damage, or morbidity rate postoperatively, compared with continuous or intermittent clamping of longer periods.


CONCLUSIONS
Hepatic vascular exclusion is an effective way to limit blood loss in hepatic resection without causing sever liver injury. However, the interleukin-6 production is increased and the morbidity rate is high. Paradoxically, periodic release of pedicular clamping increases the blood loss but does not reduce liver cell injury or interleukin-6 production.
Kimura
Fumio
F
Department of Surgery, Omiya Red Cross Hospital, Kamiochiai, Yono.
Miyazaki
Masaru
M
Suwa
Toshikazu
T
Sugiura
Toshiyuki
T
Shinoda
Tokuzou
T
Itoh
Hiroshi
H
Nakagawa
Koji
K
Ambiru
Satoshi
S
Shimizu
Hiroaki
H
Yoshitome
Hiroyuki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007432:Intraoperative Period; D007511:Ischemia / Q000097:blood / Q000209:etiology*; D008099:Liver / Q000098:blood supply* / Q000502:physiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
D015850:Interleukin-6