Application Of Block Of Lowhepar Inferior Venae Cava United Half Liver In The Liver Excision Surgery

Objective:To evaluate the effectiveness and safety of infrahepatic inferior vena cava clamping combined with hemihepatic vascular occlusion in partial hepatectomy.Methods:Part1.Animal experiments.80rabbits were randomly assigned into4groups, receiving either Pringle maneuver, hemihepatic vascular occlusion or combined with infrahepaticIVC clamping, or a blank control (processing laparotomy with no vascular manipulation). In all cases, three parameters were measured:1) CVP prior to and after vascular occlusion;2) blood loss after hepatectomy, where same part and same size of the liver were resected;3) liver function before blood flow exclusion for30minutes, and after30minutes of reperfusion.15extra rabbits were operated to evaluate the effects of infrahepatic IVC clamping on liver and renal function. Infrahepatic and suprarenal IVC was ligated in laparotomy with general aneasthesia. Post-operative vital signs, liver and renal function were recorded for seven days.Results:1. CVP decreased significantly in the first and the third group,but not in the second group.2. Blood loss during operation in three experiment groups were all less than the control group, and was the least in the third group,the first group was less than the second.3. Liver function was impaired in all three experiment groups. No significant difference was found between the second and third group, which were both better than the first group.4. Pathological results indicated similar necrotic patterns in yall three experiment groups. There was no detectable necrosis in the non-occluded area in the second and third groups. At last, single ligation of infrahepatic IVC did not have notable impact on rabbits.Part2.Clinical analysis.54cases of hepatic resection in Xiangyahosipitalbetween July2010and March2012were analyzed, including26cases of hepatic carcinoma,21cases of intrahepatic bile duct stones,5cases of hepatic hemangioma, and2cases of liver abscess. Allpatients were graded Child A before operation, and had no signs of liver cirrhosis (neither on ultrasound nor CT scan, with normal globulin levels). Pringle maneuvers, hemihepatic vascular occlusion, and infrahepatic inferior vena cava (IVC) clamping combined with hemihepatic vascular occlusion were applied in13,18, and23cases respectively, namely group A, B, and C. Occlusion time, blood loss, changes in central venous pressure (CVP) during operations and postoperative liver function were evaluated among these three groups.Results:1.There were no significant difference in occlusion time among3groups.2. Group C had less blood loss than the other two.3. CVP in group C decreased dramatically, but not in group A or B.4. Postoperative liver function was better in group C than that in group A, while remained the same as group B.Conclusion:InfrahepaticIVC clamping combined with hemihepatic vascular occlusion can lower CVP and reduce blood loss in operation, without further impairment of liver function, thus is safe and effective in hepatectomy.