title: [Application of total hemihepatic vascular exclusion in liver resection for patients with hepatocellular carcinoma and impaired liver function].
abstract: OBJECTIVE
  To study the clinical value of total hemihepatic vascular exclusion (THHVE) in liver resection for patients with hepatocellular carcinoma (HCC) and impaired liver function.
  
  
  METHODS
  The data of 70 patients who underwent liver resection for HCC with impaired liver function between January 2009 and October 2011 were analyzed retrospectively. THHVE was applied in 38 patients (THHVE group), Pringle maneuver in 25 patients (Pringle group) and no vascular occlusion in 7 patients. In the THHVE group, 36 patients were male, 2 were female, average age was (54 ± 9) years. And in Pringle group, 23 patients were male, 2 were female, average age was (53 ± 10) years. Total intraoperative blood loss, blood transfusion rate, clamping time, postoperative complication rate, postoperative hospital stay and postoperative liver function were compared between the THHVE and Pringle group.
  
  
  RESULTS
  Total blood loss ((317 ± 186) ml vs. (506 ± 274) ml, t = -3.025, P = 0.004) and transfusion rate (10.5% vs. 32.0%, χ(2) = 4.509, P = 0.034) were significantly lower in the THHVE group than in the Pringle group. Although the clamping time was longer ((21 ± 5) minutes vs. (17 ± 5) minutes, t = 3.209, P = 0.002), the total bilirubin levels on postoperative day 3 and 7 and ALT levels on postoperative day 1, 3, 7 were significantly lower in the THHVE group than in the Pringle group, and the pre-albumin level on postoperative day 7 was higher in the THHVE group than in the Pringle group. Total complication rate (26.3% vs. 52.0%, χ(2) = 4.291, P = 0.038) and major complication rate (7.9% vs. 28.0%, χ(2) = 4.565, P = 0.033) were lower in the THHVE group than in the Pringle group. And postoperative hospital stay duration was shorter in the THHVE group than in the Pringle group ((14.0 ± 2.6) d vs. (16.4 ± 4.0) d, t = -2.625, P = 0.012).
  
  
  CONCLUSIONS
  THHVE is a safe and effective technique in liver resection for patients with HCC and impaired liver function. It is associated with less blood loss, lower transfusion requirements, better postoperative liver function recovery, lower postoperative complication rate and shorter postoperative hospital stay.
authors.affiliation: Department of Special Medical Care I and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
authors.forename: Cheng-jun
authors.initials: CJ
authors.lastname: Sui
authors.forename: Jiong-jiong
authors.initials: JJ
authors.lastname: Lu
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Shen
authors.forename: Li
authors.initials: L
authors.lastname: Geng
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Bing-hua
authors.initials: BH
authors.lastname: Dai
authors.forename: Jia-mei
authors.initials: JM
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000503:physiopathology; D008113:Liver Neoplasms / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies