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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546

Abstract

GUERRA, Enilde Eloena  and  PEREIRA-LIMA, Luiz M.. Hepatic resection with afferent vascular occlusion: analysis of risk factors. Rev. Col. Bras. Cir. [online]. 2001, vol.28, n.5, pp.347-355. ISSN 0100-6991.  http://dx.doi.org/10.1590/S0100-69912001000500007.

BACKGROUND: The control of blood loss during liver resection has been related to lower rates of perioperative mortality and morbidity. Techniques to minimize intraoperative bleeding are associated with blood flow interruption to the liver, either through an afferent vascular occlusion (Pringle maneuver) or by total vascular isolation of the organ. The aim of this study was to evaluate a series of partial hepatectomies with afferent blood flow occlusion, in patients with benign or malignant diseases. METHOD: Sixty hepatic resections with inflow occlusion, in 59 patients, were analyzed in order to search possible risk factors for morbidity and mortality, the connection between the hepatic ischemic time and the transaminases variation, the prothrombin time and bilirrubins and the postoperative evolution. RESULTS: The prevalence of postoperative complications was 43% and the mortality rate was 6.7%. The significant risk factor for mortality was the long lasting operative time when compared to patients who did not die. For the postoperative morbidity, the identified risk factors were age over sixty years old, surgery for malign neoplasm, abnormal liver parenchyma, blood loss demanding replacement of more than one unity of blood transfusion and another concomitant abdominal surgery. In a multiple regression analysis, those risk factors were reduced only to abnormal hepatic parenchyma. CONCLUSIONS: The ischemia time did not have any connection with the postoperative morbidity or mortality. The transaminases levels were higher in cases of longer ischemic time, however they returned to the preoperative levels in about a week. The transaminases variations were not different amongst patients who had postoperative morbidity or not.

Keywords : Liver; Ischemia; Morbidity; Inflow occlusion.

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