Comparison of half and total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma patients undergoing hepatectomy

doi:10.3877/cma.j.issn.1674-0793.2015.04.007

Abstract

Abstract:

Objective

To compare the efficacy of half versus total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma (HCC) patients undergoing hepatectomy.

Methods

Sixty-three HCC patients undergoing hepatectomy were divided into two groups: half vascular inflow occlusion group (HIO) and total vascular inflow occlusion group (TIO). There were no hilus dissection and combined controlled low central venous pressure in both groups. Operation time, occlusion time, postoperative hospital stay, postoperative ICU stay, blood loss and transfusion during operation and postoperative day 1 and day 3 liver functions were compared.

Results

Operation time, occlusion time, postoperative ICU stay, blood loss and transfusion during operation had no significant differences between two groups. Postoperative hospital stay was significantly shorter in HIO group [(14.1±5.5) d vs (17.2±5.8) d, t=-2.142, P=0.036]. Postoperative day 1 serum albumin level was significantly higher in HIO group [(34.2±3.5) g/L vs (31.6±3.8) g/L, t=2.784, P=0.007], while levels of ALT, AST, AKP, GGT, TB, DB had no significant differences between two groups. Postoperative day 3 liver functions had no significant differences between two groups.

Conclusion

Both occlusion methods are safe and effective, while half vascular inflow occlusion leads to shorter postoperative hospital stay and higher serum albumin level the first day after operation.

Key words: Hepatocellular carcinoma, Hepatectomy, Half vascular inflow occlusion, Total vascular inflow occlusion

Jianyu Lin, Yongbiao Chen, Lizhi Lyu, Yi Jiang. Comparison of half and total vascular inflow occlusion without hilus dissection in hepatocellular carcinoma patients undergoing hepatectomy[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(04): 286-290.

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Figures/Tables 4

References 20

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项目		HIO组	TIO组	统计值	P值
例数		33	30	?	?
年龄(岁,±s)		49.9±10.9	53.2±10.2	-1.234	0.222
性别(例)		?	?	2.438	0.118
?	男	25	28	?	?
?	女	8	2	?	?
术前Child-Pugh分级(例)		?	?	0.000	1.000
?	A	32	29	?	?
?	B	1	1	?	?
肿瘤部位(例)		?	?	0.164	0.686
?	肝右叶	25	24	?	?
?	肝左叶	8	6	?	?
肿瘤数目(例)		?	?	0.379	0.538
?	单发	32	27	?	?
?	多发	1	3	?	?
是否有大血管侵犯(例)		?	?	0.000	1.000
?	是	2	2	?	?
?	否	31	28	?	?
肿瘤直径(cm,±s)		5.5±4.3	6.4±4.2	-0.183	0.419
ALT(U/L,±s)		40.7±33.9	35.1±15.7	0.791	0.432
AST(U/L,±s)		45.0±24.3	52.2±31.0	-1.031	0.307
AKP(U/L,±s)		87.5±36.7	105.6±72.1	-1.271	0.208
GGT(U/L,±s)		70.1±63.1	113.8±167.8	-1.342	0.188
TB(μmol/L,±s)		15.4±6.5	13.5±6.6	1.182	0.242
DB(μmol/L,±s)		4.5±2.4	4.0±1.7	0.767	0.134
Alb(g/L,±s)		40.9±4.5	39.2±3.5	1.708	0.093
手术方式(例)		?	?	1.310	0.519
?	局部切除	23	21	?	?
?	肝段切除	8	5	?	?
?	半肝切除	2	4	?	?

项目		HIO组	TIO组	统计值	P值
例数		33	30	?	?
年龄(岁,±s)		49.9±10.9	53.2±10.2	-1.234	0.222
性别(例)		?	?	2.438	0.118
?	男	25	28	?	?
?	女	8	2	?	?
术前Child-Pugh分级(例)		?	?	0.000	1.000
?	A	32	29	?	?
?	B	1	1	?	?
肿瘤部位(例)		?	?	0.164	0.686
?	肝右叶	25	24	?	?
?	肝左叶	8	6	?	?
肿瘤数目(例)		?	?	0.379	0.538
?	单发	32	27	?	?
?	多发	1	3	?	?
是否有大血管侵犯(例)		?	?	0.000	1.000
?	是	2	2	?	?
?	否	31	28	?	?
肿瘤直径(cm,±s)		5.5±4.3	6.4±4.2	-0.183	0.419
ALT(U/L,±s)		40.7±33.9	35.1±15.7	0.791	0.432
AST(U/L,±s)		45.0±24.3	52.2±31.0	-1.031	0.307
AKP(U/L,±s)		87.5±36.7	105.6±72.1	-1.271	0.208
GGT(U/L,±s)		70.1±63.1	113.8±167.8	-1.342	0.188
TB(μmol/L,±s)		15.4±6.5	13.5±6.6	1.182	0.242
DB(μmol/L,±s)		4.5±2.4	4.0±1.7	0.767	0.134
Alb(g/L,±s)		40.9±4.5	39.2±3.5	1.708	0.093
手术方式(例)		?	?	1.310	0.519
?	局部切除	23	21	?	?
?	肝段切除	8	5	?	?
?	半肝切除	2	4	?	?

组别	手术时间(min)	血流阻断时间(min)	术后住院时间(d)	术后ICU时间(d)
HIO组	140.7±37.4	21.4±8.0	14.1±5.5	2.4±1.6
TIO组	145.5±74.0	19.0±8.7	17.2±5.8	2.8±1.4
t值	-0.327	1.108	-2.142	-1.047
P值	0.745	0.272	0.036	0.299

组别	手术时间(min)	血流阻断时间(min)	术后住院时间(d)	术后ICU时间(d)
HIO组	140.7±37.4	21.4±8.0	14.1±5.5	2.4±1.6
TIO组	145.5±74.0	19.0±8.7	17.2±5.8	2.8±1.4
t值	-0.327	1.108	-2.142	-1.047
P值	0.745	0.272	0.036	0.299

组别	ALT(U/L)	AST(U/L)	AKP(U/L)	GGT(U/L)	TB(μmol/L)	DB(μmol/L)	Alb(g/L)
HIO组	486.6±359.6	565.9±435.7	99.7±42.5	60.6±54.2	23.5±12.7	6.6±5.2	34.2±3.5
TIO组	477.3±299.5	569.7±318.6	98.1±41.0	66.1±56.4	20.2±8.1	6.3±3.0	31.6±3.8
t值	0.112	-0.039	0.155	-0.396	1.183	0.333	2.784
P值	0.911	0.969	0.878	0.693	0.241	0.740	0.007^a

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