Non-bleeding technique in resection of hepatoma: report of 49 cases

To investigate the experience and some related problems of non-bleeding technique in partial hepatectomy.

49 cases of hepatic tumors were reviewed, including 41 cases of hepatic carcinoma, 3 cases of secondary hepatic carcinoma, 4 cases of haemangioma, and 1 case of hepatic adenoma. Three kinds of bleeding control technique including normothermic complete hepatic vascular exclusion (47/49), complete vascular isolation with hypothermic perfusion (1/49), and partial extracorporeal hepatectomy (1/49) were employed.

The intraoperative volume of blood loss was 1560+/-1252 ml, and operative duration was 4.7+/-0.8 h. One case died perioperatively because of severe bleeding. 31 cases of primary hepatic carcinoma were followed up, the 0.5-, 1-, and 5-year survival rates were 77% (24/31), 55% (17/31), and 36% (11/31) respectively.

In liver surgery concerning hepatoma in the segment of Couinaud I, IV, V or VIII, Pringle's procedure is still the major method for bleeding control. When the vena cava or/and venae hepaticae was/were implicated, normothermic complete hepatic vascular exclusion is helpful. The partial extracorporeal technique can provide a good exposure to the cava inferior, and is an alternative to the complete extracorporeal method. Intraoperative B ultrasound detection plays an important role in choosing bleeding control technique.