Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 DINGHe-yi , TAIQin-wen , ZHOUCheng-ming , YUBing-bing , WENHao ,  ZHANGJin-hui

The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding?author：

ZHANGJin-hui, Email: zhangjinhui2001@sina.cn

Keywords：

Hepatectomy; Hemihepatic vascular occlusion; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140081

Video：

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Objective To assess the effectiveness of hemihepatic vascular occlusion (HHO) and total hepatic inflow occlusion (THO) which were applied in the liver resection. Methods Randomized controlled trials (RCTs) comparing HHO and THO in hepatectomy were electro-nically searched from CENTRAL (Issue 1, 2013), PubMed, EMbase, CBM, CNKI and Digital Journals of Chinese Medical System. The English or Chinese version of relevant published and unpublished data and their references were also retrieved by hand. The last retrieval date was in May 2013. The data were extracted and the quality was evaluated by two reviewers independently, and then RevMan 5.2 software was used for data analysis. Results Ten RCTs involving 788 patients were finally included. The results of meta-analysis showed that, HHO reduced the levels of aspartate transaminase (AST) (WMD=-235.84, 95%CI-411.28 to-60.40, P=0.008) and alanine aminotransferase (ALT) (WMD=-195.52, 95%CI-351.87 to-39.16, P=0.01) in 1 day postoperatively. HHO also shortened the recovery time of AST (WMD=-3.83, 95%CI-4.52 to-3.15, P < 0.000 01) and ALT (WMD=-4.29, 95%CI-5.75 to-2.84, P < 0.000 01) postoperatively, and shortened the recovery time of gastrointestinal function (WMD=-1.52, 95%CI-2.75 to-0.29, P=0.02). However, HHO was the same as THO in intraoperative haemorrhage and postoperative transfusion and hospital stay. Conclusion HHO applied in liver resection could relieve the damage of liver function, and shorten the recovery time of gastrointestinal function postoperatively. Due to the poor quality of the included studies, more high quality RCTs with longer follow-up are required to further verify the aforementioned conclusion.

Citation： DINGHe-yi, TAIQin-wen, ZHOUCheng-ming, YUBing-bing, WENHao, ZHANGJin-hui. Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(4): 469-477. doi: 10.7507/1672-2531.20140081 Copy

1.	Belghiti J, Kabbej M, Sauvanet A, et al.Drainage after elective hepatic resection:A randomized trial.Ann Surg, 1993, 218(6):748-753.
2.	Shimada M, Takenaka K, Fujiwara Y, et al.Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.Br J Surg, 1998, 85(2):195-198.
3.	Ibrahim S, Chen CL, Lin CC, et al.Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.Liver Transpl, 2006, 12(6):950-957.
4.	Yoshimura Y, Kubo S, Shirata K, et al.Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma.World J Surg, 2004, 28(10):982-986.
5.	Pringle JH.Notes on the arrest of hepatie hemorrhage due to trauma.Ann Surg, 1908, 48(4):541-549.
6.	Makuuchi M, Mori T, Gunven P, et al.Safety of hemihepatic vascular occlusion during of the liver.Surg Gynecol Obstet, 1987, 164(2):155-158.
7.	Higgins J, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration, 2011.Available at:www.cochrane-handbook.org.
8.	Figueras J, Llado L, Ruiz D, et al.Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial.Ann Surg, 2005, 241(4):582-590.
9.	Liang G, Wen T, Yan L, et al.A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.Hepatogastroenterology, 2009, 56(91-92):745-750.
10.	Si-Yuan FU, Yee LW, Guang-Gang L, et al.A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy.Am J Surg, 2011, 201(1):62-69.
11.	Wu CC, Yeh DC, Ho WM, et al.Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques.Arch Surg, 2002, 137(12):1369-1376.
12.	張忠寶, 關中正, 王亮.半肝血流阻斷法用于肝切除術效果觀察.山東醫藥, 2011, 51(35):57-58.
13.	張玉惠, 張偉忠, 梁金榮.肝葉切除中兩種肝血流阻斷方式的臨床療效比較.中國基層醫藥, 2011, 18(24):3390-3391.
14.	秦凱, 聶雙發.半肝血流阻斷在肝癌手術切除中的應用研究.貴陽醫學院學報, 2010, 35(6):581-582.
15.	黃穎峰, 唐偉鏢, 楊劭宇.半肝血供阻斷術和Pringle術對肝硬化腫瘤患者肝功能的影響.現代醫學, 2006, 6(8):20-21.
16.	劉力, 張穎, 鄭向奎, 等.半肝與全肝人肝血流阻斷法肝切除術的臨床觀察:附56例報告.中國普通外科雜志, 2008, 17(7):727-728.
17.	羅毅, 秦紅軍, 羅偉.半肝和全肝人肝血流阻斷技術在肝切除術中的應用比較.中國醫師進修雜志, 2011, 34(23):36-37.
18.	Nakai T, Koh K, Funai S, et al.Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection.Am Coll Surg, 1999, 189(3):300-304.
19.	陳煒, 孫勇偉, 吳志勇.半肝血流阻斷在肝硬化肝癌半肝切除術中的意義.肝膽外科雜志, 2005, 13(4):260-262.
20.	梁冠林, 陳哲宇, 文天夫.常溫下連續阻斷半肝血流60min在乙肝肝硬變患者肝切除術中的應用.中國普外基礎與臨床雜志, 2008, 7(15):503-507.
21.	Yin XY, Lai PB, Lee JF, et al.Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis.Br J Surg, 2000, 87(11):1510-1515.
22.	吳志科.半肝血流阻斷在原發性肝癌肝臟部分切除術中的應用觀察.中國當代醫學, 2011, 18(34):31-32.
23.	李諍.選擇性半肝血流阻斷和Pringle's法對肝切除術后患者肝功能的影響.醫藥前沿, 2012, (36):191-192.
24.	周飛國, 劉才峰, 黃亮, 等.多處肝切除治療復雜肝膽管結石病的并發癥分析及防治.肝膽胰外科雜志, 2009, 21(2):110-114.
25.	盧軍華, 楊田, 楊廣順, 等.右半肝切除治療右側及雙側肝內膽管結石.第二軍醫大學學報, 2008, 29(6):609-614.
26.	Yeh DC, Wu CC, Ho WM, et al.Bacterial translocation after cirrhotic liver resection:a clinical investigation of 181 patients.Surg Res, 2003, 111(2):209-214.

1. Belghiti J, Kabbej M, Sauvanet A, et al.Drainage after elective hepatic resection:A randomized trial.Ann Surg, 1993, 218(6):748-753.
2. Shimada M, Takenaka K, Fujiwara Y, et al.Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.Br J Surg, 1998, 85(2):195-198.
3. Ibrahim S, Chen CL, Lin CC, et al.Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.Liver Transpl, 2006, 12(6):950-957.
4. Yoshimura Y, Kubo S, Shirata K, et al.Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma.World J Surg, 2004, 28(10):982-986.
5. Pringle JH.Notes on the arrest of hepatie hemorrhage due to trauma.Ann Surg, 1908, 48(4):541-549.
6. Makuuchi M, Mori T, Gunven P, et al.Safety of hemihepatic vascular occlusion during of the liver.Surg Gynecol Obstet, 1987, 164(2):155-158.
7. Higgins J, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration, 2011.Available at:www.cochrane-handbook.org.
8. Figueras J, Llado L, Ruiz D, et al.Complete versus selective portal triad clamping for minor liver resections:a prospective randomized trial.Ann Surg, 2005, 241(4):582-590.
9. Liang G, Wen T, Yan L, et al.A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.Hepatogastroenterology, 2009, 56(91-92):745-750.
10. Si-Yuan FU, Yee LW, Guang-Gang L, et al.A prospective randomized controlled trial to compare Pringle maneuver, hemihepatic vascular inflow occlusion, and main portal vein inflow occlusion in partial hepatectomy.Am J Surg, 2011, 201(1):62-69.
11. Wu CC, Yeh DC, Ho WM, et al.Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients:a randomized comparison of hemihepatic and total hepatic occlusion techniques.Arch Surg, 2002, 137(12):1369-1376.
12. 張忠寶, 關中正, 王亮.半肝血流阻斷法用于肝切除術效果觀察.山東醫藥, 2011, 51(35):57-58.
13. 張玉惠, 張偉忠, 梁金榮.肝葉切除中兩種肝血流阻斷方式的臨床療效比較.中國基層醫藥, 2011, 18(24):3390-3391.
14. 秦凱, 聶雙發.半肝血流阻斷在肝癌手術切除中的應用研究.貴陽醫學院學報, 2010, 35(6):581-582.
15. 黃穎峰, 唐偉鏢, 楊劭宇.半肝血供阻斷術和Pringle術對肝硬化腫瘤患者肝功能的影響.現代醫學, 2006, 6(8):20-21.
16. 劉力, 張穎, 鄭向奎, 等.半肝與全肝人肝血流阻斷法肝切除術的臨床觀察:附56例報告.中國普通外科雜志, 2008, 17(7):727-728.
17. 羅毅, 秦紅軍, 羅偉.半肝和全肝人肝血流阻斷技術在肝切除術中的應用比較.中國醫師進修雜志, 2011, 34(23):36-37.
18. Nakai T, Koh K, Funai S, et al.Comparison of controlled and Glisson's pedicle transections of hepatic hilum occlusion for hepatic resection.Am Coll Surg, 1999, 189(3):300-304.
19. 陳煒, 孫勇偉, 吳志勇.半肝血流阻斷在肝硬化肝癌半肝切除術中的意義.肝膽外科雜志, 2005, 13(4):260-262.
20. 梁冠林, 陳哲宇, 文天夫.常溫下連續阻斷半肝血流60min在乙肝肝硬變患者肝切除術中的應用.中國普外基礎與臨床雜志, 2008, 7(15):503-507.
21. Yin XY, Lai PB, Lee JF, et al.Effects of hepatic blood inflow occlusion on liver regeneration following partial hepatectomy in an experimental model of cirrhosis.Br J Surg, 2000, 87(11):1510-1515.
22. 吳志科.半肝血流阻斷在原發性肝癌肝臟部分切除術中的應用觀察.中國當代醫學, 2011, 18(34):31-32.
23. 李諍.選擇性半肝血流阻斷和Pringle's法對肝切除術后患者肝功能的影響.醫藥前沿, 2012, (36):191-192.
24. 周飛國, 劉才峰, 黃亮, 等.多處肝切除治療復雜肝膽管結石病的并發癥分析及防治.肝膽胰外科雜志, 2009, 21(2):110-114.
25. 盧軍華, 楊田, 楊廣順, 等.右半肝切除治療右側及雙側肝內膽管結石.第二軍醫大學學報, 2008, 29(6):609-614.
26. Yeh DC, Wu CC, Ho WM, et al.Bacterial translocation after cirrhotic liver resection:a clinical investigation of 181 patients.Surg Res, 2003, 111(2):209-214.

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Hemihepatic Inflow Occlusion versus Total Hepatic Inflow Occlusion in Liver Resection: A Meta-Analysis

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