The Effecacy Analysis On Different Hepatic Blood Flood Occlusion In Hepatectomy Of Liver Cirrhosis Combined With Hepatocarcinoma

Objective:To investigate and compare the effects of blood loss during operationand liver function after operation on three different hepatic blood flood occlusion inhepatectomy of liver cirrhosis，and then to evaluate the optimal method for hepaticblood occlusion in hepatectomy of liver cirrhosis combined with hepatocarcinoma.Methods:A retrospective study has been carried out in63cases with hepaticmalignant tumors who have been treated in the Department of Hepatobiliary Surgery ofFriendship Hospital affiliated to Dalian Medical University from June,2002toDecember,2012. All cases have had hepatectomy and are accompanied with laboratoryevidence of hepatic fibrosis by after-operation pathology.All the63patients weredivided into three groups according to different techniques of hepatic blood flowocclusion. IPM(Intermittent hepatic inflow occlusion)group(n=22)：The hepatic inflowwas blocked for15minutes and after that with5minutes of reflow，this cycle continuesuntil resection was completed.HPM(Hemihepatic vascular occlusion)group(n=20)：After porta hepatis wasdissected and the left and right hepatic vessel were separated，the ipsilateral hepaticblood was precluded and the contralateral hepatic blood was kept flowing untilresection finished.IP(Ischemic preconditioning)group(n=21)：The hepatic inflow wasblocked for5minutes and after that with5minutes of reflow，after that hepatic bloodwas occluded continuously until resection was completed. Age、the hepatic functionbefore operation、tumor size(cm)、average time of blood occlusion(min)and volumeof bleeding(ml) of three different techniques of hepatic blood occlusion werecompared. And the changes of ALT、AST、TB level at the1st,3rd,7th,14th day afteroperation was compared among three groups and patients of the blocking time less than20minutes in three groups. Results:There was no significant difference between three groups in the age、thehepatic function before operation、tumor size(cm)、average time of blood occlusion(min)statistically.The mean blood loss of IP group was the least in hepatectomy，andIPM was the most. There was significant difference between them statistically (P <0.05).For the change of ALT、AST and TB at the1st,3rd,7th day after operationbetween three groups. In comparison with IPM and IP group，the level of ALT、ASTand TB decreased apparently in HPM group，there was significant difference amongthem statistically (P <0.05or或P<0.01).At the14th day after operation，comparingwith IPM and IP group，there was significant difference in HPM group(P <0.05). Thelevel of ALT at the1st,3rd,7th day after operation and AST at the1st,3rd day afteroperation in IPM group were prior to IP group. There was significant differencebetween them statistically (P <0.05).But the level of TB at the3rd day afteroperation in IP group was lower than that in IPM group(P<0.05). In the comparison ofthe level of ALT、AST、TB in the patients of the blocking time less than20minutesamong three groups，the liver function of IP group improved significantly afteroperation.Compared with IPM group，the level of ALT and AST at the1st,3rd，7th and14th day after operation were statistically significant (P <0.05)，and the level of TBat the1st,7th day after operation were statistically significant (P<0.05).The liverfunction improved significantly after operation among the patients of the blocking timeless than20minutes in IP group，but the level of ALT at the1st,3rd day and AST at the3rd day after operation in IP group were higher than those in HPM group.There wassignificant difference between them statistically (P <0.05).Conclusion:1.Compared with HPM and IPM，IP can decrease blood loss during operationsignificantly.2.IP can reduce IRI of patients with liver cirrhosis，but it has certain correlationwith the blocking time. Within the20minutes of the blocking time，IP reduced the IRIof liver apparently.3.When patients with liver cirrhosis were in hepatectomy，if the operation wascomplicated and the expected time(the blocking time that expected was longer，beyond20minutes)was long，HPM was the first choice，the second was IPM，IP was the worsttechnique.4.If the blocking time that expected was shorter(less than20minutes)，IP could be used.This technique can not only reduce the blood loss during surgery，but also can decrease the IRI on the residual liver，it have reached the sameeffect with HPM.