Major liver resection without clamping: A prospective reappraisal in the era of modern surgical tools

被引:34
作者
Scatton, O
Massault, PP
Dousset, B
Houssin, D
Bernard, D
Terris, B
Soubrane, O
机构
[1] Hop Cochin, Serv Chirurg, F-75014 Paris, France
[2] Hop Cochin, Serv Anesthesie & Reanimat, F-75014 Paris, France
[3] Hop Cochin, Serv Anat Pathol, F-75014 Paris, France
关键词
D O I
10.1016/j.jamcollsurg.2004.06.013
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Hemorrhage and transfusions remain the main causes of mortality and morbidity from liver resection. In cases of extended resection, especially performed on diseased liver, ischemia-reperfusion injury related to pedicle clamping may be a significant risk factor of postoperative liver dysfunction. The ideal alternative would be to perform major hepatectomy without clamping and without significant bleeding. STUDY DESIGN: This prospective study aimed to reconsider the risk of major hepatectomy performed without pedicle clamping and under low venous pressure in the light of modern surgical tools. Inclusion criteria were adults requiring a resection of more than three segments on healthy or pathologic livers but not on preoperative documented cirrhosis. RESULTS: Fifty patients, with a mean age of 53 +/- 15 years were included. Twenty-two patients had underlying liver disease. The main indications were colorectal metastases, primary liver tumors, and living donation. Twenty-six right hepatectomies, 17 extended right hepatectomies, and 7 extended left hepatectomies were performed. Unclamping method was successful in 96% of patients on an intention-to-treat basis. Seventy-four percent of patients were not transfused and no patients died. Surgical complication rate was 16% but no complication led to reoperation. Medical complication rate was 20%, including three transient liver dysfunctions. CONCULSIONS: Major hepatectomy without clamping can be performed safely. The low rate of postoperative liver dysfunction, especially in cases of underlying liver disease, suggests good preservation of the small and diseased remnant liver. ((C) 2004 by the American College of Surgeons).
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页码:702 / 708
页数:7
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