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Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis

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Abstract

Background

Hepatic veins remain patent during complete inflow occlusion (CIO) and bleeding from them may continue. Occlusion of the inferior vena cava (ICV) during CIO may reduce blood loss from hepatic veins. This study was designed to compare the overall outcomes after application of CIO with or without occlusion of the ICV below the liver in complex mesohepatectomy for hepatocellular carcinoma (HCC) patients with cirrhosis.

Materials and methods

One hundred and eighteen (118) patients were randomly assigned to CIO or a modified technique of hepatic vascular exclusion (MTHVE). Hemodynamic parameters were evaluated and the amount of blood loss, measurement of liver enzymes, and postoperative progress were recorded.

Results

Blood loss during liver transection in CIO groups was significantly greater than that in MTHVE group (P=0.046). Thus, incidence of blood transfusion was significantly greater in patients of the CIO group (P=0.041). There were no significant differences in liver enzyme changes, bilirubin, or morbidity in the postoperative period between the two groups.

Conclusions

CIO with occlusion of the ICV below the liver is a safe, effective, and feasible technique during mesohepatectomy in HCC patients with cirrhosis. Excellent results were obtained with minimized bleeding, limited hepatic function damage, and low rate of postoperative complications.

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Acknowledgements

The authors thank Professor Y. J. Wang, Department of Public Health and Environmental Medicine, Tongji Medical College, for statistical analysis. This work was supported by the key clinical project fund [No. 321 (2001)] from the Chinese Ministry of Public Health.

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Authors and Affiliations

  1. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China

    Xiao-ping Chen, Zhi-wei Zhang, Bi-xiang Zhang, Yi-fa Chen, Zhi-yong Huang, Wan-guang Zhang, Song-qing He & Fa-zu Qiu

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  1. Xiao-ping Chen
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  2. Zhi-wei Zhang
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Correspondence to Xiao-ping Chen.

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Chen, Xp., Zhang, Zw., Zhang, Bx. et al. Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis. Langenbecks Arch Surg 391, 209–215 (2006). https://doi.org/10.1007/s00423-006-0043-7

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  • DOI: https://doi.org/10.1007/s00423-006-0043-7

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