Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy

作者：Boleslawski Emmanuel^*; Decanter Gauthier; Truant Stephanie; Bouras Ahmed Fouad; Sulaberidze Lasha; Oberlin Olivier; Pruvot Francois Rene

来源：Hepato Pancreato Biliary, 2012, 14(10): 688-699.

DOI：10.1111/j.1477-2574.2012.00519.x

Background: Right hepatectomy (RH) is the most common type of major hepatectomy and can be achieved without portal triad clamping (PTC) in non-cirrhotic liver. The present study reviews our standardized policy of performing RH without systematic PTC. Methods: One hundred and eighty-one consecutive RH were performed in non-cirrhotic patients, with division of the right afferent and efferent blood vessels prior to transection, without systematically using PTC. Prospectively collected data were analysed, focusing on the following endpoints: need for salvage PTC, ischaemic time, blood loss and post-operative outcome. Results: Extra-hepatic division of the right hepatic vessels was feasible in all patients, but was ineffective in 48 patients (26.5%) who required salvage PTC during transection. In those patients, the median ischaemic time was 20 min. The median blood loss was 500 ml (503000). Six patients (3.3%) experienced post-operative liver failure. Overall morbidity, severe morbidity and mortality were 42%, 12.1% and 1.6%, respectively, with peri-operative transfusion rate (16.6%) being the only factor associated with morbidity. Discussion: By performing RH with extra-hepatic vascular division prior to transection, PTC can be safely avoided in the majority of patients.

• 出版日期2012-10