Application of selective hepatic vascular exclusion in hepatectomy for liver hemangioma

Abstract

Objective To assess the application value of selective hepatic vascular exclusion (SHVE) in the resection for liver hemangioma. Methods Two hundred and thirty-two patients with liver hemangioma were included in this retrospective study. All the patients underwent liver hemangioma resection from January 2003 to December 2010 in the East Hepatobilliary Surgery Hospital with the tumor size over 5 cm and located in the junction of hepatic veins and postcava and oppressing at least one of the three major hepatic veins (right, middle or left). Local ethical committee approval was received and that the informed consent of all participating subjects was obtained. The patients were divided into SHVE group and Pringle maneuver (Pringle) group according to the methods vascular of occlusion. Pringle maneuver was conducted primarily in the SHVE group and hepatic vein tourniquet and Satinsky clamp were applied during the operation. In the SHVE group, there were 41 males and 51 females with average age of 45 years old. In the Pringle group, there were 61 males and 78 females with average age of 43 years old. The operation time, liver warm ischemia time, blood loss and transfusion during the operation, the postoperative Intensive Care Unit (ICU) stay and hospital stay were recorded and compared using the t test or Wilcoxon test. The complications during and after the operation, resorting to total hepatic vascular exclusion (THVE), reoperation and death were monitored and were compared using the χ2 test or Fisher exact test. Results In the SHVE group, the median operation time was (140±65) min, the blood loss during the operation was 300-1 600 (600 ml), the blood transfusion was 0-8 (2) units. However, the corresponding indexes were (127±40) min、500-7 000 (1 000) ml、0-33 (4) unites respectively in the Pringle group. There were significant differences between 2 groups in each index (P 0.05) . The incidence of postoperative complications in the SHVE group and Pringle group were 17(16/92) and 31%(43/140) respectively. There were significant differences between 2 groups(χ2=4.33, P 0.05). Two patients underwent reoperation in both groups for the bleeding of liver wounds. No death was observed in the SHVE group. Two cases died of air embolism and MODS respectively in the Pringle group. There was also no significant difference between 2 groups in the operative mortality. Conclusions In the hepatectomy for liver hemangioma located in the junction of hepatic veins and postcava, SHVE has some advantages in controlling the massive blood loss of lacerated hepatic veins and preventing the postoperative complications. It can reduce the intraoperative bleeding and the incidence of postoperative complications. Key words: Hemangioma, liver; Hepatectomy; Hepatic vein; Total hepatic vascular exclusion; Pringle maneuver