Application of right hemihepatic blood flow occlusion in anatomical right posterior lobectomy

Abstract

Objective To evaluate the application value of right hemihepatic blood flow occlusion in the anatomical right posterior lobectomy. Methods Clinical data of 81 patients undergoing anatomical right posterior lobectomy in Hunan Provincial People's Hospital between January 2010 and February 2015 were retrospectively analyzed. The patients were divided into three groups according to the methods of liver blood flow occlusion. In the right hemihepatic blood flow occlusion group (method Ⅰ group), there were 26 cases including 12 males and 14 females with a mean of (48±9) years. In the regional blood flow occlusion of right posterior lobe group (method Ⅱ group), there were 34 cases including 15 males and 19 females with a mean of (48±10) years. In the Pringle's maneuver group (method Ⅲ group), there were 21 cases including 10 males and 11 females with a mean of (48±10) years. The informed consents of all patients were obtained and the local ethical committee approval was received. In method Ⅰ group, the right hepatic pedicle occluding band was prepared for spare, or the right hepatic artery and the right branch of portal vein were dissected and occluded separately. In method Ⅱ group, the right posterior branch of right hepatic artery and the right posterior branch of portal vein were separated, ligated and resected on the basis of method Ⅰ. In method Ⅲ group, porta hepatis was not dissected. The operation time, intraoperative hemorrhage volume and blood transfusion were observed in three groups. Clinical data among three groups were compared by one-way ANOVA and LSD-t test. Results The operation time in method Ⅰ group was (168±52) min, which was significantly shorter compared with (216±39) and (193±43) min in method Ⅱ and method Ⅲ group (LSD-t=-4.093, -1.772; P<0.05). The intraoperative hemorrhage volume in method Ⅰ group was (200±62) ml, which was significantly less compared with (403±38) and (303±37) ml in method Ⅱ and method Ⅲ group (LSD-t=-15.671, -12.735; P<0.05). Conclusion Right hemihepatic blood flow occlusion is a safe and feasible technique for controlling hemorrhage during the anatomical right posterior lobectomy, which significantly decreases the intraoperative hemorrhage volume, shortens operation time and reduces surgical risk. Key words: Hepatectomy; Pringle maneuver; Time; Blood loss, surgical; Transaminases