Background: Total hepatic vascular exclusion (THVE) and selective
hepatic vascular exclusion (SHVE) are two effective techniques for
bleeding control in major hepatic resections. Outcomes of the two
procedures were compared.
Methods: Patients undergoing major liver resection were randomly
allocated to the THVE and SHVE groups. Intraoperative hemodynamic
changes and the postoperative course of the two groups were compared.
Results: During vascular clamping, the THVE group showed a significant
elevation in pulmonary vascular resistance, systemic vascular
resistance. intrapulmonary shunts, and a significant reduction in
cardiac index, compared with the SHVE group (P <0.05). Patients
undergoing THVE received more crystalloids and blood, showed more severe
liver, renal and pancreatic dysfunction, and had a longer hospital stay
than the SHVE group (P <0.05).
Conclusions: Both techniques are equally effective in bleeding control
in major liver resections. THVE is associated with cardiorespiratory and
hemodynamic alterations and may be not tolerated by some patients. SHVE
is well tolerated with fewer postoperative complications and shorter
hospitalization time. (C) 2002 Excerpta Medica, Inc. All rights
reserved
