Comparison Of The Application Between Infrahepatic Inferior Vena Cava Clamping Involving Pringle Maneuver And Selective Hepatic Vascular Exclusion In Hepatectomy

Objective The study aims to compare the safety and efficacy of infrahepatic inferior vena cava clamping involving the Pringle maneuver with that of selective hepatic vascular exclusion in hepatectomy.Materials & Methods Part One Literatures concerning the portal traid clamping versus infrahepatic inferior vena cava clamping involving the Pringle maneuver and the portal triad clamping versus selective hepatic vascular exclusion have been systematically reviewed according to the total blood loss during surgery and the postoperative morbidity, respectively. Taking the portal triad clamping as a reference, an indirect meta-analysis comparing infrahepatic inferior vena cava clamping involving the Pringle maneuver with selective hepatic vascular exclusion has been conducted. Part Two Patients with infrahepatic inferior vena cava clamping involving the Pringle maneuver or selective hepatic vascular exclusion from 2006 to 2013 were enrolled in this retrospective analysis. The total blood loss during surgery was the primary endpoint of the study. The second endpoints included intraoperative transfusion number and rate, portal triad occlusion time, operation time, recovery of liver and renal function after surgery, hospital stay after surgery, postoperative mortality and morbidity.Result Part One Total 4 Literatures have been enrolled in the analysis in accordance with the inclusion and exclusion criterion. Among these, one article compared 60 patients using infrahepatic inferior vena cava clamping involving the Pringle maneuver with 58 individuals using the portal triad clamping. The mean difference and the 95% confidence interval of the total blood loss during surgery were 350 ml and(246-454) ml. The other three papers have conducted a comparison of 155 patients with selective hepatic vascular exclusion and 155 candidates with the portal triad clamping. The respective results were 251 ml and(40-462) ml. There was no dead case in either group. There exits significant difference in the total blood loss between the two interventions by indirect comparing infrahepatic inferior vena cava clamping involving the Pringle maneuver with selective hepatic vascular exclusion(P<0.05). Part Two In the infrahepatic inferior vena cava clamp involving the Pringle maneuver group of 940 patients, the total perioperative blood loss was 250(10-5000) ml, the number and rate of transfusion were 203 and 21.6%, and the postoperative morbidity of complications was 344(36.6%). Meanwhile, the corresponding indexes of selective hepatic vascular exclusion group consisting of 447 patients were 300(10-8000) ml, 122(27.3%) and 196(43.8%), respectively. The differences between the two groups were significant, even after three covariates had been chosen(P<0.05). Also significant difference in total blood loss during surgery and intraoperative transfusion of two groups has been elucidated in the 447 pair individuals after propensity score matching(P<0.05). There were no differences between the two groups in the duration of portal triad clamping, recovery of liver function after surgery, hospital stay after surgery, postoperative mortality(P>0.05).Conclusion Both the infrahepatic inferior vena cava clamping involving the Pringle maneuver and selective hepatic vascular exclusion applied in hepatectomy are safe and effective after system review and large-scale retrospective analysis. Compared with selective hepatic vascular exclusion, infrahepatic inferior vena cava clamping involving the Pringle maneuver shows potential benefits of decreased total blood loss and intraoperative transfusion, no increase in postoperative complication rates.