Application of hemihepatic vascular occlusion through hilar plate in resection of hepatocellular carcinoma

Abstract

Objective To investigate the application value of hemihepatic vascular occlusion through hilar plate during hepatectomy for patients with hepatocellular carcinoma. Methods Retrospective analysis was conducted in 72 patients with hepatocellular carcinoma who underwent hepatectomy from June 2007 to June 2012 in the First People’s Hospital of Foshan. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. All the patients were divided into hemihepatic occlusion group and Pringle maneuver group according to the method of vascular occlusion. Thirty cases(25 male, 5 female, mean age of 42 years) were included in the hemihepatic occlusion group, in which, hepatectomy was performed on the left half liver(n=8), left lateral lobes (n=2), right lobe(n=12), right anterior lobes (n=3), right posterior lobes (n=5), respectively. Forty-two cases(35 male, 7 female, mean age of 45 years) were included in the Pringle maneuver group, in which, hepatectomy was performed on the left half liver (n=11), left lateral lobes (n=3), right half liver(n=18), right anterior lobes (n=2), right posterior lobes (n=8), respectively. The time of operation, porta hepatis clamping, blood loss during operation, postoperative hospital stay were recorded. Alanine aminotransferase(ALT), albumin(ALB) and total bilirubin(TB) on day 1, 3, and 7 after operation were monitored. Mortality and postoperative complications including hemorrhage, hepatic failure, bile leakage and seroperitoneum were also detected. The t test was made to compare the difference between two groups in the time of operation, porta hepatis clamping, blood loss during operation, postoperative hepatic function and hospital stay. Results The operation time of the hemihepatic occlusion group and Pringle maneuver group were (221±51) min and (211±41) min respectively. There was no significant difference between two groups (t=1.576, P=0.122) . The time of porta hepatis clamping in the hemihepatic occlusion group was (34.5±3.4) min, which was evidently longer than that of the Pringle maneuver group was (24.0±2.5) min (t=2.541, P=0.015). The blood loss during operation in two groups were (466±91) ml and (403±80) ml respectively. There was no significant difference (t=1.013, P=0.331) . The ALB on day 1, 3, and 7 after operation in the hemihepatic occlusion group were higher than that in the Pringle maneuver group while the ALT, TB were lower than those in the Pringle maneuver group. There was no significant difference between two groups (all in P<0.05). The hospital stay in two groups were (6.7±1.3) d and (8.5±2.6) d, which demonstrated significant difference (t=2.447, P=0.018) . No mortality, hemorrhage or hepatic failure was found in two groups. One case in the Pringle maneuver group suffered bile leakage after the operation and were cured by removing the drainage tube 21 days later. And 1 case suffered massive ascites and recovered by the use of albumin and diuretics. Conclusions The hemihepatic vascular occlusion through hilar plate in hepatectomy of hepatocellular carcinoma is a safe and effective technique for controlling the hepatic blood flow, with the advantage of less damage to liver function, quick recovery after operation and low incidence of complicatons. Key words: Carcinoma, hepatocellular; Hepatectomy; Hemihepatic vascular occlusion; Pringle maneuver