[Comparative study of selective hepatic vascular exclusion and Pringle maneuver in hepatectomy involving the second porta hepatis].

OBJECTIVE: To compare the effects of selective hepatic vascular exclusion (SHVE) and Pringle maneuver in resecting the liver tumors involving the second porta hepatis.

METHODS: From January 2000 to October 2005, 2100 liver tumors were resected, among which 235 tumors adhered to or were very close to one or more hepatic veins. Both SHVE and Pringle maneuver were used to control the blood loss during the hepatectomy. They were divided into two groups: SHVE group (125 cases) and Pringle group (110 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. SHVE group included total SHVE (clamping of the porta hepatis and all major hepatic veins) in 25 cases and partial SHVE (clamping of the porta hepatic and one or two hepatic veins) in 100 cases. Three methods were used to occlude hepatic veins: be ligated with suture, be encircled and occluded with tourniquets and be clamped with Shatinsky clamps directly.

RESULTS: There was no difference between the 2 groups regarding the age, sex, tumor size, cirrhosis and HBsAg positive rate, ischemia time and operating time (P > 0.05). Intra-operative blood loss and transfusion requirements were decreased significantly in the SHVE group. Hepatic veins ruptured with massive blood loss in 14 and air embolism in 3 in Pringle group, but there was no massive blood loss and air embolism in SHVE group. Postoperative bleeding, reoperation, liver function failure and mortality rate were higher in Pringle group (P < 0.05), ICU stay and hospital stay were longer in Pringle group (P < 0.05).

CONCLUSIONS: SHVE is much more effective than Pringle maneuver for controlling intraoperative bleeding. It can prevent massive blood loss and air embolism resulting from hepatic veins ruptured and can reduce the postoperative complications rate and mortality rate. Clamping the hepatic veins with Shatinsky clamp is safer and easier than encircled and occluded with tourniquets.