Application Of Retrohepatic Inferior Vena Cava Semi-occlusion Combined With Low Central Venous Pressure In Laparoscopic Hemihepatectomy

Objective: To evaluate the value of retrohepatic inferior vena cava semi-occlusion combined with low central venous pressure in laparoscopic hepatectomy.Methods: The clinical data of 14 patients with liver cancer who underwent laparoscopic hemihepatectomy in the Department of Hepatobiliary surgery of Xiangxi Autonomous Prefecture people’s Hospital from 01 June 2019 to October 1,2021 were analyzed retrospectively,and compared with 30 patients who underwent laparoscopic hemihepatectomy in the same period.All patients or their guardians have signed a preoperative informed consent form and have been submitted to the Medical Research Ethics Committee of Xiangxi Autonomous Prefecture people’s Hospital for examination and approval.In the observation group,14 patients were treated with pringle occlusion,retrohepatic inferior vena cava occlusion and low central venous pressure(LCVP).The control group included 30 patients with pringle occlusion and low central venous pressure(LCVP).The intraoperative and postoperative observation indexes of the two groups were recorded and compared,including mean central venous pressure(CVP)and mean arterial pressure(MAP),transected bleeding and transfusion volume,operation time and total operation time,inflammatory indexes,albumin,total bilirubin,alanine aminotransferase and creatinine on the 1st,3rd and 5th day after operation.Statistical software was used for comparative analysis.Results: Patients in both groups were successfully completed under laparoscopic surgery without conversion to laparotomy.The average value of interrupted hepatic venous pressure(LCVP)and the amount of transected liver bleeding in the observation group were significantly lower than those in the control group,and the difference was statistically significant [(1.1 ±0.5)cm H2Ovs(2.7 ±0.6)cm H2 O,P < 0.001;(106.2± 45.2)mlvs(268.5 ± 56.1)ml,P < 0.001].There was no significant difference in mean hepatic arterial pressure,hepatectomy time,total operation time and inflammatory indexes,albumin,total bilirubin,alanine aminotransferase and creatinine between the two groups on the 1st,3rd and 5th day after operation(P > 0.05).Conclusion: The main results are as follows:(1)The application of retrohepatic inferior vena cava semi-occlusion technique in laparoscopic hemihepatectomy is beneficial to further reduce the central venous pressure(CVP)during hepatectomy,and then reduce the intraoperative blood loss,and shorten the operation time to some extent,so as to improve the efficiency of laparoscopic hepatectomy.(2)Compared with the control group,there was no significant difference in inflammatory indexes,albumin,total bilirubin,alanine aminotransferase and creatinine in the observation group after operation.therefore,it is considered that retrohepatic inferior vena cava semi-blocking technique combined with low central venous pressure is safe for laparoscopic hepatectomy.