Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver

Otsubo, Takehito; Takasaki, Ken; Yamamoto, Masakazu; Katsuragawa, Hideo; Katagiri, Seiji; Yoshitoshi, Kenji; Hamano, Mie; Ariizumi, Shun‐ichi; Kotera, Yoshihito

doi:10.1016/s0039-6060(03)00343-x

Cited by 81 publications

(65 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Blood loss during liver resection is proportional to the pressure gradient of vascular walls and the diameter of the injured vessels. Though total hepatic vascular exclusion or clamping inferior vena cava can reduce blood loss from hepatic venous system during hepatectomy [7] , they are associated with remarkable injury and technically difficult.…”

Section: Discussionmentioning

confidence: 99%

Low central venous pressure reduces blood loss in hepatectomy

Wang¹,

Liang²,

Huang³

et al. 2006

WJG

210

159

View full text Add to dashboard Cite

CONCLUSION: LCVP is easily achievable in technique.Maintenance of CVP ≤ 4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function. INTRODUCTIONHepatectomy remains as the treatment of choice for hepatocellular carcinoma (HCC). Intra-operative blood loss is one of the major causes for post-operative morbidity and mortality. Various techniques, such as Pringle's maneuver and unilateral hepatic hilum occlusion, have been used to control bleeding from hepatic arterial and portal venous systems during hepatectomy in clinical settings. However, for excision of HCC adjacent to major blood vessels, hepatic system could be the major source of hemorrhage, especially after the application of Pringle's maneuver. Hence, effective control of hepatic venous hemorrhage is crucial to minimize intraoperative blood loss. This prospective randomized clinical trial aims at evaluating the role of low central venous pressure (LCVP) in reducing blood loss during hepatectomy for HCC. MATERIALS AND METHODS Patients'data and groupingFrom June 2002 to December 2003, a total of 50 consecutive patients with HCC (40 men and 10 women) underwent hepatectomy by the same group of surgeons at our hospital. By the sealed envelope method, the patients were blindly randomized into LCVP group (n = 25) and control group (n = 27) at the beginning of the operation. Two patients in the control group were excluded from the study because hepatectomy was given up due to cardiac arrest in one and unclear tumor demarcation in the other. Eventually, there were 25 patients in each group. The demographic data of the patients are shown in Table 1

show abstract

Section: Discussionmentioning

confidence: 99%

Low central venous pressure reduces blood loss in hepatectomy

Wang¹,

Liang²,

Huang³

et al. 2006

WJG

210

159

View full text Add to dashboard Cite

show abstract

“…3 It is therefore necessary to find a serological marker that helps evaluate the extent of any liver injury induced by hepatectomy.…”

Section: Introductionmentioning

confidence: 99%

Correlation between plasma miR-122 expression and liver injury induced by hepatectomy

et al. 2013

View full text Add to dashboard Cite

Objective: This study aimed to define the correlation between microRNA-122 (miR-122) expression and hepatectomy-induced liver injury in patients with hepatocellular carcinoma (HCC). Methods: Plasma miR-122 expression in patients with HCC and healthy age-matched controls was determined, and correlated with plasma alanine transaminase activity (ALT) and bilirubin levels preoperatively and on days 1 and 7 postoperation. Correlations between plasma miR-122 and clinicopathological characteristics at 1 day postoperation were also determined. Results: This study included 80 patients with HCC and 80 controls. Baseline expression of miR-122 mRNA and ALT in patients with HCC was significantly higher than in controls. MiR-122 expression correlated with ALT and bilirubin levels preoperatively and on days 1 and 7 postoperatively. In patients with HCC who received a block of the first hepatic portal during surgery and those with excised tumour size >5 cm, plasma miR-122 expression was significantly increased on day 1 postoperatively, compared with expression levels in those who did not receive a block and those with smaller tumours. Conclusions: Plasma miR-122 expression is correlated with hepatectomy-induced liver injury in patients with HCC. Increase in miR-122 expression could be used as an index of such injury before and after hepatectomy in these patients.

show abstract

“…However, TVE or total clamping of the inferior vena cava can induce a major central hypovolemia and may be associated with intra-and post-operative renal and heart disturbance [1,14,15]. Some surgeons encountered paradoxical bleeding from the cut surface with TVE, and this was thought to be due to obstruction of the drainage routes of the adrenal and subphrenic vein by TVE [16].…”

Section: Discussionmentioning

confidence: 99%

“…Complete IVC clamping of the vena cava below the liver with the inflow occlusion has been reported [16]. However, using the total IVC clamping method is associated with a low blood pressure in some cases and may be difficult in patients with severe cirrhosis [16].…”

Section: Discussionmentioning

confidence: 99%