全肝与半肝入流阻断技术在肝切除术中的临床应用评价

肝癌电子杂志 ›› 2021, Vol. 8 ›› Issue (3): 55-58.

全肝与半肝入流阻断技术在肝切除术中的临床应用评价

黄小准¹, 王春玲², 黄璋侃¹, 徐林¹, 马腾¹, 殷鑫¹, 毕新宇³, 车旭¹

1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院肝胆外科,广东深圳 518116;
2.惠州市中心人民医院肝病内科,广东惠州 516000;
3.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京 100021

收稿日期:2021-03-04 出版日期:2021-09-30 发布日期:2021-10-20
通讯作者: 车旭,E-mail：drchexu@126.com; 毕新宇,E-mail：beexy1971@163.com
作者简介:黄小准主治医师,中国医学科学院肿瘤医院深圳医院,肝胆外科
基金资助:
深圳市“医疗卫生三名工程”项目资助（SZSM202011010）

Research progress on Pringle maneuver and half hepatic vascular exclusion in hepatectomy

Huang Xiaozhun¹, Wang Chunling², Huang Zhangkan¹, Xu Lin¹, Ma Teng¹, Yin Xin¹, Bi Xinyu³, Che Xu¹

1. Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong, China;
2. Department of Hepatology, Huizhou Municipal Central Hospital, Huizhou 516001, Guangdong, China;
3. Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2021-03-04 Online:2021-09-30 Published:2021-10-20

摘要/Abstract

摘要： 肝切除手术过程复杂、难度大,如何有效地应用阻断技术控制术中出血是成功实施肝切除术的关键因素,目前肝脏血流阻断方式的选择更多依赖于外科医生的个人喜好,本文将基于现有的循证医学证据对全入肝血流阻断法和半肝入流阻断法在肝切除手术中的应用和研究进展作一综述。

关键词: 肝癌, 肝切除, 肝脏血流阻断

Abstract: As we all know, it is complex and difficult in doing hepatic surgery. Thus, how to apply blocking technology effectively in intraoperative bleeding control had become the key factor for liver resection. Consider that the hepatic blood flow occlusion modes usually were chosen by surgeons according to their preferences, this paper, based on the existing evidence, is to make a review on research and application of blood flow blocking method and half hepatic inflow blocking method in liver surgery.

Key words: Primary liver cancer, Liver resection, Hepatic vascular exclusion

黄小准, 王春玲, 黄璋侃, 徐林, 马腾, 殷鑫, 毕新宇, 车旭. 全肝与半肝入流阻断技术在肝切除术中的临床应用评价[J]. 肝癌电子杂志, 2021, 8(3): 55-58.

Huang Xiaozhun, Wang Chunling, Huang Zhangkan, Xu Lin, Ma Teng, Yin Xin, Bi Xinyu, Che Xu. Research progress on Pringle maneuver and half hepatic vascular exclusion in hepatectomy[J]. Electronic Journal of Liver Tumor, 2021, 8(3): 55-58.

参考文献

[1] SI M B, YAN P J, HAO X Y, et al.Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: A systematic review and meta-analysis[J]. Surg Endosc, 2019, 33(8):2419-2429.
[2] NANASHIMA A, NAGAYASU T.Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures[J]. Surg Today, 2016, 46(4):398-404.
[3] CESCON M, VETRONE G, GRAZI G L, et al.Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years[J]. Ann Surg, 2009, 249(6):995-1002.
[4] HOUBEN P, HINZ U, KNEBEL P, et al.Randomized controlled trial on Pringle Maneuver to reduce blood loss during stapler hepatectomy - PriMal StHep[J]. BMC Surgery, 2019, 19(1):60.
[5] PRINGLE J H.V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma[J]. Ann Surg, 1908, 48(4):541-549.
[6] BELGHITI J, NOUN R, MALAFOSSE R, et al.Continuous versus intermittent portal triad clamping for liver resection: a controlled study[J]. Ann Surg, 1999, 229(3):369-375.
[7] CAPUSSOTTI L, NUZZO G, POLASTRI R, et al.Continuous versus intermittent portal triad clamping during hepatectomy in cirrhosis. Results of a prospective, randomized clinical trial[J]. Hepatogastroenterology, 2003, 50(52):1073-1077.
[8] GURUSAMY K S, SHETH H, KUMAR Y, et al. Methods of vascular occlusion for elective liver resections[J]. Cochrane Database Syst Rev, 2009, 21(1): CD007632.
[9] MAN K, MAN K.Tolerance of the liver to intermittent pringle maneuver in hepatectomy for liver tumors[J]. Arch Surg, 1999, 134(5):533-539.
[10] WU CC, HWANG C R, LIU T J, et al.Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver[J]. Br J Surg, 1996,83(1):121-124.
[11] LAU W Y, LAI E C H, LAU S H Y. Methods of vascular control technique during liver resection:a comprehensive review[J].Hepatobiliary Pancreat Dis Int, 2010, 9(05):473-481.
[12] BISMUTH H.Surgical anatomy and anatomical surgery of the liver[J]. World J Surg, 1982, 6(1):3-9.
[13] TANAKA K, SHIMADA H,TOGO S, et al.Outcome using hemihepatic vascular occlusion versus the pringle maneuver in resections limited to one hepatic section or less[J]. J Gastrointest Surg, 2006, 10(7):980-986.
[14] MAKUUCHI M, MORI T, P GUNVÉN, et al. Safety of hemihepatic vascular occlusion during resection of the liver[J]. Surg Gynecol Obstet, 1987, 164(2):155-158.
[15] GOTOH M, MONDEN M, SAKON M, et al.Hilar lobar vascular occlusion for hepatic resection[J]. J Am Coll Surg, 1994, 178(1):6-10.
[16] WANG H Q, YANG J Y, YAN L N.Hemihepatic versus total hepatic inflow occlusion during hepatectomy: A systematic review and meta-analysis[J]. World J Gastroenterol, 2011, 17(26):3158-3164.
[17] WU C C, YEH D C, HO W M, et al.Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques[J]. Arch Surg, 2002, 137(12):1369-1372.
[18] WEN Y, MIAO X, XIONG L, et al.Application of hemihepatic vascular occlusion with hanging maneuver in hepatectomy[J]. Hepatogastroenterology, 2009, 56(90):442-446.
[19] 丁贺义, 邰沁文, 周成明, 等. 肝切除术应用半肝与全肝入肝血流阻断法效果的Meta分析[J].中国循证医学杂志, 2014, 14(4):469-477.
[20] WANG Z Y, CHEN Q L, SUN L L, et al.Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies[J]. BMC Cancer, 2019, 19(1):1047.
[21] WANG C, HUANG Z, HUANG X, et al.Surgical outcomes between patients with and without a cirrhotic liver undergoing laparoscopic liver resection: A meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2018, 42(6):553-563.
[22] FUXT, TANG Z, CHEN JF, et al.Laparoscopic hepatectomy enhances recovery for small hepatocellular carcinoma with liver cirrhosis by postoperative inflammatory response attenuation: a propensity score matching analysis with a conventional open approach[J]. Surg Endosc, 2021, 35(2):910-920.
[23] MIZUGUCHI T, KAWAMOTO M, NAKAMURA Y, et al.New technique of extracorporeal hepatic inflow control for pure laparoscopic liver resection[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(1):e16-25.
[24] DUA M M, WORHUNSKY D J, HWA K, et al.Extracorporeal Pringle for laparoscopic liver resection[J]. Surg Endosc, 2015, 29(6):1348-1355.
[25] ZHANG Y, YANG H, DENG X, et al.Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection[J]. Surg Endosc, 2016, 30(3):961-970.
[26] 李传涛, 王兆映, 周迟,等. 腹腔镜肝切除术应用半肝与全肝入肝血流阻断法效果的Meta分析[J]. 牡丹江医学院学报,2020,41(4), 15-22.
[27] HUANG J, TANG W, HERNANDEZ-ALEJANDRO R, et al.Intermittent hepatic inflow occlusion during partial hepatectomy for hepatocellular carcinoma does not shorten overall survival or increase the likelihood of tumor recurrence[J]. Medicine (Baltimore), 2014, 93(28):e288.
[28] LIU S, LI X, LI H, et al.Longer duration of the Pringle maneuver is associated with hepatocellular carcinoma recurrence following curative resection[J]. J Surg Oncol, 2016, 114(1):112-118.
[29] LEE K F, CHONG C C N, CHEUNG S Y S, et al. Impact of intermittent pringle maneuver on long-term survival after hepatectomy for hepatocellular carcinoma: Result from two combined randomized controlled trials[J]. World J Surg, 2019, 43(12):3101-3109.
[30] LEE K F, CHEUNG Y S, WONG J, et al.Randomized clinical trial of open hepatectomy with or without intermittent Pringle manoeuvre[J]. Br J Surg, 2012, 99(9):1203-1209.
[31] LEE K F, WONG J, CHEUNG S Y S, et al. Does intermittent pringle maneuver increase postoperative complications after hepatectomy for hepatocellular carcinoma? A randomized controlled Trial[J]. World J Surg, 2018, 42(10):3302-3311.
[32] JIA C, DAI C, WANG H, et al.Differential effects of three techniques for hepatic vascular exclusion during resection for liver cirrhosis on hepatic ischemia-reperfusion injury in rats[J]. Gastroenterol Res Pract, 2018, 2018(10):1-10.
[33] 李洋, 刘作金, 龚建平. 肝缺血-再灌注损伤对大鼠肠黏膜屏障功能及肠道菌群易位的影响[J]. 中华器官移植杂志, 2007, 28(3):150-153.
[34] NI J, LAU W Y, YANG Y, et al.A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis[J]. J Gastrointest Surg, 2013, 17(8):1414-1421.