International Medical Journal, Vol. 20., Iss. 3, 2014, P. 67−71.
Application of vascular liver exclusion during liver resection
V. T. Zaitsev Institute of General and Urgent Surgery (National Academy of Medical Sciences of Ukraine), Kharkiv, Ukraine
Significant hemorrhage together with blood transfusion increase postoperative morbidity and mortality after hepatic resection. Hepatic vascular occlusion is effective in minimizing bleeding during hepatic parenchymal transection. Investigation into less traumatic method of vascular occlusion during liver resection is an urgent problem of hepatic surgery due to a high level of complications such as liver failure. The purpose of this work was to determine the optimal model of vascular clamping. Experimental and clinical research was done. Forty white giant rabbits were divided randomly into 4 groups (n = 10 in each). Different models of vascular exclusion were compared. The research showed that vascular occlusion with ischemic preconditioning in the mode 5/10/15 was the most delicate technique. Clinical investigation involved 152 patients who underwent liver resection within the period of 2008−2013. An algorithm of application of afferent liver vascular exclusion, which improved the results of surgical treatment of patients with focal pathologies mainly due to the reduction of intraoperative blood loss (from 902 ml to 478 ml) and minimize the manifestations of ischemia−reperfusion syndrome was suggested. This decreased postoperative complications (from 32.7 % to 21.6 %) and mortality rate (from 5.8 % to 1.96 %).
Key words: liver resection, Pringle−maneuver, ischemia−reperfusion syndrome.