The Clinical Application Of Hepatic Veins Occlusion For Complicated Hepatectomy

Objective: Total hepatic vascular exclusion (THVE) and selective hepatic vascular exclusion (SHVE) are two effective techniques for bleeding control in hepatic resections.Selective hepatic vascular exclusion (SHVE) is also called hepatic veins occlusion.Unfortunately,due to the hemodynamic alterations induced by IVC occlusion, a substantial number of patients cannot tolerate this procedure. Outcomes of the two procedures were compared.To evaluate the effect of hepatic veins occlusion on the resection of liver tumours .Methods: Patients undergoing major liver resection were randomly allocated to the THVE and SHVE groups.Forty patients (28 male, 12female; median age 44 years) underwent an liver resection. A malignant tumor in 34 and a benign tumor in 6 cases indicated hepatic resection.Classified according to Couinaud, the liver resections included 7 right lobectomies, 4 left lobectomies,1 extended left lobectomies, 6 central hepatectomies and 22 resection of segments. Swan- Ganz catheter was inserted in patients to record the hemodynamic changes . Mean arterial pressure( MAP), cardiac index (CI), and mean pulmonary artery pressure (MPAP) were measured, while systemic vascular resistance (SVR), pulmonaryvascular resistance (PVR) were calculated by standard formulas. Hemodynamic changes during the resections and after vascular occlusion of the two groups were compared. Also the postoperative course were compared.Results: One of 20 patients who did not tolerate THVE,was excluded from the study. The 39 patients eligible for final analysis were assigned either to the THVE group (n = 19) or the SHVE group (n =20).During vascular clamping, the THVE group showed a significant elevation in PVR, SVR, and a significant reduction in CI,MAP,MPAP,compared with the SHVE group (P<0.05). Despite the fact that estimated blood loss and operative time were similar in both groups, the THVE group received crystalloid fluids than the SHVE group (P <0.05). On the postoperative day, the THVE technique appeared to be not much more injurious to the liver, kidney compared with SHVE Patients undergoing THVE showed no significant difference on liver, renal dysfunction, and postoperative complications compared with the SHVE group. (P>0.05). There were no deaths in our series. The usual complications ensuing from liver surgery were encountered in both groups .The complications were unrelated to the technique used.Conclusions: Both techniques are equally effective in bleeding control in liver resections. THVE is not always tolerated by patients, but it is essential when the lesion adheres or encompasses the IVC.SHVE provides a bloodless transection plane and allows for resections and repairs of the hepatic veins and it is always well-tolerated. In conclusion, Hepatic veins occlusion on the hepatectomy is safe, effective to peform with better hemodynamics, especially to prevent from bleeding and air embolism.