Techniques of Inflow Occlusion for Liver Resection

Limited resection can be a therapeutic approach in patients with cirrhosis with very low remnant hepatic function after resection. In this study, two hilar vascular clamping methods (hilar selective clamping In 13] and hilar lobar clamping method In 8]), which were used for resection ofhepatocellular carcinoma in patients with cirrhosis, were compared based on cardiovascular stability during clamping, intraoperative bleeding, operative time and postoperative course. In the past, the Pringle method had been used (n 19) and those instances were included for comparison'. The mean operation time of the lobar clamping group was 209 + 44 minutes, which was significantly less than that of the selective clamping group (259 + 44 minutes, p < 0.05). Furthermore, the mean intraoperative blood loss of the lobar clamping group was 920 + 400 milliliters, which was significantly less than that of the selective clamping group (1,640 + 590 milliliters, p < 0.01). The postoperative total bilirubin and glutamine-oxaloacetic transaminase levels tended to be high in the Pringle group, but there was no significant difference between the groups. Although the blood pressure during clamping significantly decreased in all groups, the decrease was profound in the Pringle group as compared with those in the other two groups. Thus, as a method for controlling afferent bloodflow during hepatic resection in patients with cirrhosis, we recommend the lobar clamping method as a simple, safe and effective way to minimize bleeding and maintain cardiovascular stability. liver cirrhosis. hepatocellular carcinoma PAPER DISCUSSION The risk of severe intraoperative haemorrhage occuring when the liver parenchyma is divided has led to research into means of controlling the vascular inflow and outflow to the liver. In 1908, J. Hogarth Pringle of Glasgow published a paper entitled "Notes on the arrest of hepatic haemorrhage due to trauma". This was the first time that total clamping of the hepatic pedicle in order to arrest haemorrhage had been proposed. In hepatectomy, partial occlusion has long been practised by those who divided the hepatic pedicle structures outside the liver. However, Makuuchi has extended this technique to dissection of the hepatic pedicle structures outside the liver for clamping of the branches beyond the confluence without division. Thus in the removal of the right lateral sector of the liver, for example, the right hepatic artery and right branch of the portal vein are dissected and clamped. The principles of anterior intrahepatic approach were first elaborated by Ton That Tung. …