[Selective exclusion of hepatic outflow and inflow in hepatectomy for huge hepatic tumor].
OBJECTIVE
To evaluate the effects of selective hepatic vascular exclusion (SHVE) on prevention of serious hemorrhage and air embolism during hepatectomy and on the liver function after operation.


METHODS
From January 2004 to March 2007, 29 huge hepatic tumors were resected in our department. Both SHVE and Pringle maneuver were used to control the blood loss during hepatectomy. They were divided into two groups: SHVE group (15 cases) and Pringle group (14 cases). Data regarding the intraoperative and postoperative courses of the patients were analyzed.


RESULTS
There was no significant difference between the two groups regarding the age, sex, tumor size, cirrhosis, HbsAg positive rate and operating time (P > 0.05). Intraoperative blood loss was reduced significantly in the SHVE group (P < 0.05). The serum prealbumin levels on the postoperative day 1, 3 and 7 in SHVE group were significantly higher than those in the Pringle group (P < 0.05). The serum ALT value in SHVE group was significantly lower than that in the Pringle group on postoperative day 1, 3 and 7. The mean drainage volume in SHVE group was significantly less than that in the Pringle group on postoperative day 1 and 2. Liver failure occurred in two cases of the Pringle group, while no one in the SHVE group. Rupture of hepatic vein with massive blood loss occurred in 3 cases and air embolism in one case of the Pringle group, but did not occur in any case of the SHVE group.


CONCLUSIONS
When the selective exclusion of hepatic outflow and inflow is applied in hepatectomy, the resection rate of huge hepatic tumors and operative tolerance of hepatectomy are improved. It is a safe and rational operation type, and provides an optimal choice for hepatectomy.
Hu
Zhi-ming
ZM
Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Wu
Wei-ding
WD
Zhang
Cheng-wu
CW
Zhang
Yu-hua
YH
Ye
Zai-yuan
ZY
Zhao
Da-jian
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001650:Bile Duct Neoplasms / Q000097:blood / Q000098:blood supply / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000098:blood supply / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000097:blood / Q000098:blood supply / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008099:Liver / Q000098:blood supply / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D055815:Young Adult
D011228:Prealbumin; D000410:Alanine Transaminase