Intermittent Hepatic Vein–Total Vascular Exclusion During Liver Resection: Anatomic and Clinical Studies

摘要: Bleeding from hepatic veins remains a problem during liver surgery. Perceived difficulties in the dissection and isolation of these retrohepatic venous structures have limited widespread use vein control resection. The purpose this study was to delineate anatomy apply knowledge series patients undergoing resection with intermittent vein-total vascular exclusion (IHV-TVE). A detailed description formulated using 20 cadaveric dissections conjunction anatomic descriptions 30 hepatectomies. With benefit improved knowledge, we evaluated 45 consecutive major resections which were isolated technique IHV-TVE applied. hepatocaval ligament must be divided isolate right vein. It closely associated caudate 69% time. who underwent portal triad occluded intermittently (20 minutes 5 reperfusion) Rommel tourniquets. Mean total warm ischemic time 65 +- 24.5 minutes. estimated blood loss 864 514 ml. Eighteen percent required transfusions. Complications identified 16 (35.5%), average length hospital stay 10.5 3.4 days. There no deaths. Detailed allows for safe extrahepatic well tolerated may intraoperative loss.