| Objective: To explore the effect of 4 methods of hepatic blood flow blocking on blood loss during operation and liver function after operation in hepatectomy.Methods: We analyzed retrospectively datum of 80 patients with hepatic tumor had been carried out hepatectomy in the Fourth Hospital of Hebei Medical University from January 2014 to January 2016. All the 80 patients were divided into 4 groups according to different methods of hepatic blood flow occlusion. A group was Pringle Maneuver’s group(n = 30). We blocked persistently the first porta hepatis until hepatectomy was completed, but the total time was control in 20 minutes B group was intermittent Pringle Maneuver’s group(n=30). The hepatic inflow was blocked for 15 minutes and after that with 5 minutes of reflow until hepatectomy was completed. C group was hemi-Pringle Maneuver’s(n = 10), We dissected the porta hepatis, the left and right branches of hepatic artery, the left and right branches of portal vein. The ipsilateral hepatic blood was precluded and the contralateral hepatic blood was kept flowing until hepatectomy was finished. D group was ischemic preconditioning’s group(n=10). The hepatic inflow was blocked for 1-5 minutes and after that with 5 minutes of reflow, then hepatic blood was occluded for 15 minutes and after that with 5 minutes of reflow continuous until resection was completed. We compared with the patents’ gender, age, tumor size, preoperative and postoperative liver function, the average time of hepatic portal blocking and intraoperative blood loss(ml) in the 4 groups.Results: There were no statistical differences in 4 groups in gender, age, hepatic function before operation(ALT、AST、TB、ALB), tumor size, whether or not suffer from hepatitis B and average time of hepatic portal blocking(P>0.05). The blood loss of group C was the least, and group B was the most. Compared with other 3 groups, the blood loss of Group B was increased obviously(P < 0.05).Comparison of postoperative numeric of ALT, AST, TB and ALB for 4 group of patients:ALT: Compared with group B, group A increased obviously than group B on the first day and the third day(P < 0.05); Compared with group C, group A increased obviously than group C on the first day, the third day, the fifth day and the seventh day(P < 0.05); There were no statistical differences between Group A and group D; Compared with group C, group B increased obviously than group C on the third day(P < 0.05); Compared with group D, group B was reduced obviously significantly than group D on the first day(P < 0.05); Compared with group D, group C was reduced obviously than group D on the first day and third day(P < 0.05).AST: The change of AST was similar as AST.TB: Compared with group B and C, group A increased obviously than group B and group C on the first day and third day(P < 0.05); Compared with group D, group A increased obviously than group D on the first day, the third day and the fifth day(P < 0.05); Compared with group C, group B increased obviously than group C on the third day and the fifth day(P < 0.05); Compared with group D, group B was reduced obviously significantly than group D on the first day, but group B increased obviously than group D on the fifth day and seventh day(P < 0.05); Compared with group D, group C was reduced significantly than group D on the first day and the third day(P < 0.05).Conclusion: 1 Recovery of liver function after hepatectomy was associated to methods of hepatic blood flow blocking.2 In the different methods of hepatic blood flow blocking, the hemiPringle Maneuver’s method was the slightest and the Pringle Maneuver’s method was the worst to liver function in the 4 groups.3 Effect of the intermittent Pringle Maneuver’s group was superior to the ischemic preconditioning’s group, but late liver function recover of the ischemic preconditioning’s group was faster than the intermittent Pringle Maneuver’s group.4 The bleeding of intermittent Pringle Maneuver’s group was obviously more than other groups. |
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