Chirurgia del Fegato a Firenze!

Dal 1° Marzo 2023, Chirurgia del Fegato sarà all'Università di Firenze
AOUC Azienda Ospedaliero-Universitaria Careggi - Largo Brambilla, 3 - 50134 Firenze

Esclusione vascolare del fegato con preservazione del flusso cavale nelle resezioni epatiche

Daniel Cherqui, all’ Hôpital Henri Mondor–Université Paris XII, Créteil, Francia, descrive la tecnica di esclusione vascolare del fegato con preservazione del flusso cavale durante l’esecuzione delle resezioni epatiche.

La tecnica prevede il completo isolamento dell’intera vena cava inferiore retroepatica dalla faccia posteriore del fegato.

L’esclusione vascolare viene ottenuta con il clampaggio contemporaneo del peduncolo epatico e delle vene sovraepatiche prima del loro ingresso nella vena cava inferiore.

Cherqui ne descrive l’applicazione in 40 interventi chirurgici di cui 16 eseguiti in pazienti con un’epatopatia cronica. Nessun paziente di questa serie ha richiesto la somministrazione di trasfusioni di sangue durante la resezione epatica.

La referenza bibliografica per questo evento è:

Daniel Cherqui, Benoît Malassagne, Pierre-Ivan Colau, Francesco Brunetti, Nelly Rotman, Pierre-Louis Fagniez: Hepatic vascular exclusion with preservation of the caval flow for liver resections. In: Annals of Surgery, vol. 230, no. 1, pp. 24 – 30, 1999, ISSN: 00034932, (Cited by: 113; All Open Access, Green Open Access).

Abstract

Objective: To report the technique and results of an alternative method of vascular clamping during liver resections. Background: Most liver resections require vascular clamping to avoid excessive blood loss. Portal triad clamping is often sufficient, but it does not suppress backflow bleeding, which can be prevented only by hepatic vascular exclusion. The latter method adds clamping of the inferior vena cava, which results in hypotension, requiring invasive anesthetic management. There is growing evidence that intermittent clamping is better tolerated than continuous clamping, especially in the presence of underlying liver disease. Methods: Hepatic vascular exclusion with preservation of the caval flow (HVEPC) involved conventional inflow clamping associated with outflow control by clamping the major hepatic veins, thus avoiding caval occlusion. HVEPC was used in 40 patients undergoing major or complex liver resection, including 16 with underlying liver disease. HVEPC was total (clamping of the porta hepatis and all major hepatic veins) in 20 cases and partial (clamping of the porta hepatis and the hepatic veins of the resected territory) in 20. Clamping was continuous in 22 cases and intermittent in 18. Resections included 12 hemi- hepatectomies, 12 extended hepatectomies, 3 central hepatectomies, and 13 uni- or bisegmentectomies. Results: Hemodynamic tolerance of clamping was excellent in all cases, without the need for therapeutic adjustment. Median red cell transfusion requirements were 0 units, and 28 patients (70%) did not receive any transfusions during the hospital stay. There were no deaths, and the morbidity rate was 17.5%. Median hospital stay was 10 days. Conclusion: HVEPC is a safe and effective procedure applicable to liver tumors without invasion to the inferior vena cava. It offers the advantages of conventional hepatic vascular exclusion without its hemodynamic drawbacks, and it can be applied intermittently or partially.

manda un messaggio a https://t.me/@ChirurgiaFegato

Invia subito una richiesta con Telegram

Apri direttamente Telegram ed inviaci un SMS veloce e sicuro: riceverai una risposta alla tua necessità in tempi brevissimi

Chirurgia del Fegato all'Università di Firenze!

Chirurgia Epato-Bilio-Pancreatica

AOUC Azienda Ospedaliero-Universitaria Careggi
Largo Brambilla, 3 – 50134 Firenze

Manda una mail a: info@chirurgiadelfegato.it

oppure

Invia un messaggio con Telegram