title: Selective hepatic vascular exclusion versus pringle maneuver in partial hepatectomy for liver hemangioma compressing or involving the major hepatic veins.
abstract: Massive blood loss remains a problem during resection for giant liver hemangioma. This present study was designed to compare selective hepatic vascular exclusion (SHVE) versus Pringle maneuver in surgery for liver hemangioma compressing the major (right, middle, or left) hepatic veins. From January 2003 to December 2011, 589 consecutive patients with hemangioma underwent liver resection in our department, and 273 patients had their tumors compressing at least one of the three major hepatic veins (right, middle, or left). Either SHVE (n = 120 patients) or Pringle maneuver (n = 153 patients) was used to minimize blood loss during resection. Data regarding the intraoperative and postoperative courses of these patients were retrospectively analyzed. There was no significant difference between the two groups of patients regarding age, sex, tumor size, types of hepatectomy, and extent of tumor involvement of the major hepatic veins. Intraoperative blood loss, transfusion requirements, and transfusion volume were significantly less in the SHVE group (P < 0.01). For the Pringle group, major hepatic veins were lacerated in 19 patients during hepatic parenchymal transection. For the SHVE group, a major hepatic vein was lacerated during extrahepatic dissection of the hepatic vein in two patients and during hepatic parenchymal transection in 14 patients. SHVE was more efficacious in minimizing intraoperative bleeding during liver resection for hemangiomas compressing the major hepatic veins. It prevented intraoperative major bleeding and air embolism and significantly decreased postoperative liver failure and in-hospital mortality.
authors.affiliation: The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, National Innovation Alliance for Hepatitis & Liver Cancer, Second Military Medical University, Shanghai, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yang
authors.forename: Ling-Hao
authors.initials: LH
authors.lastname: Zhao
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Fu
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Gu
authors.forename: Zhen-Guang
authors.initials: ZG
authors.lastname: Wang
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006503:Hepatic Veins / Q000473:pathology* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome