Intervention Review

Vascular occlusion for elective liver resections

  1. Kurinchi Selvan Gurusamy1,*,
  2. Yogesh Kumar2,
  3. Rajarajan Ramamoorthy1,
  4. Dinesh Sharma1,
  5. Brian R Davidson1

Editorial Group: Cochrane Hepato-Biliary Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 22 AUG 2008

DOI: 10.1002/14651858.CD007530


How to Cite

Gurusamy KS, Kumar Y, Ramamoorthy R, Sharma D, Davidson BR. Vascular occlusion for elective liver resections. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007530. DOI: 10.1002/14651858.CD007530.

Author Information

  1. 1

    Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK

  2. 2

    Leeds Teaching hospital, General Surgery, Leeds, UK

*Kurinchi Selvan Gurusamy, University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Vascular occlusion is used to reduce blood loss during liver resection. There is considerable controversy regarding whether vascular occlusion should be used or not during elective liver resections.

Objectives

To assess the advantages (decreased blood loss and peri-operative morbidity) and disadvantages (ischaemia-reperfusion injury related complications like liver dysfunction) of vascular occlusion during elective liver resections.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until August 2008.

Selection criteria

We included randomised clinical trials comparing vascular occlusion versus no vascular occlusion during elective liver resections (irrespective of language or publication status).

Data collection and analysis

Two authors independently assessed trials for inclusion and independently extracted the data. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. We calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI) based on intention-to-treat or available case analysis.

Main results

We identified a total of five trials (of high bias-risk) which compared vascular occlusion (n = 166) versus no vascular occlusion (n = 165). Three of the five trials comparing vascular occlusion and no vascular occlusion used intermittent vascular occlusion. There was no difference in mortality, liver failure, or other morbidities. The blood loss was significantly lower in vascular occlusion compared with no vascular occlusion. The liver enzymes were significantly elevated in the vascular occlusion group compared with no vascular occlusion.

Authors' conclusions

Intermittent vascular occlusion seems safe in liver resection. However, it does not seem to decrease morbidity. More randomised trials seem to be needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intermittent vascular occlusion is safe but does not decrease morbidity in liver resection

More than 1000 elective (planned operation) liver resections are performed annually in the United Kingdom alone. When liver resection is performed, the inflow of blood to the liver can be blocked (vascular occlusion), thereby reducing the blood loss. It is a controversial issue whether this causes more problems than solutions. We assessed the safety and effectiveness of vascular occlusion compared to no vascular occlusion in liver resection. We included five randomised clinical trials in this review. All trials had high risk of bias ('systematic error'). A total of 331 patients were randomised to vascular occlusion (n = 166) versus to no vascular occlusion (n = 165) in the five trials. The statistical analysis of the data demonstrates that intermittent vascular occlusion is a safe procedure, and that it reduces blood loss during operation. The trials did not demonstrate significant difference regarding mortality and liver failure, but data were sparse and more randomised trials seem to be needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

血流阻斷術用於選擇性肝臟切除

血流阻斷術用來減少肝臟切除過程中的出血量。對於是否在選擇性肝臟切除過程中應當使用血流阻斷術存有極大的爭議。

目標

評估血流阻斷術在選擇性肝臟切除過程中使用的好處(減少血液損失和手術期間發病率)和害處(和缺血再灌注損害有關的併發症,例如肝臟官能障礙) 。

搜尋策略

我們搜尋截至2008年8月的The Cochrane HepatoBiliary Group Controlled Trials Register, The Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE、EMBASE和Science Citation Index Expanded。

選擇標準

我們收錄在選擇性肝臟切除過程中比較血流阻斷術和無血流阻斷術的隨機臨床試驗(不受語言或發表狀態的限制)。

資料收集與分析

兩位作者單獨評估需要收錄的試驗,摘錄數據。我們使用有RevMan 以固定效果模式和隨機效果模式分析資料。 我們根據治療意向或已獲取的個案分析,計算危險比 (OR), 平均差(MD)或標準平均差(SMD)及其95% 信賴區間(CI)。

主要結論

我們確定一共有5次試驗 (高誤差風險)比較血流阻斷術(n = 166) 和無血流阻斷術(n = 165)。5個試驗有三個試驗使用間歇性血流阻斷術去和血流阻斷術和無血流阻斷術比較。在死亡率, 肝臟衰竭或其他患病率方面沒有差異。 和無血流阻斷術相比, 血流阻斷術的血液損失明顯較低。和無血流阻斷術組相比, 血流阻斷術組的肝功能明顯增加。

作者結論

間歇性血流阻斷術看似在肝臟切除中使用安全。但是似乎不能減低發病率.。需要更多的隨機試驗。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

間歇性血流阻斷術看似使用在肝臟切除中安全的,但是似乎不能減低發病率:每年單獨在英國就要實施1000例以上的選擇性(計畫內手術) 肝臟切除手術。實施肝臟切除手術之後, 需要阻止血液流入肝臟(血流阻斷術),這樣才能減少出血量。對於這種做法是否會引起更多的問題。我們評估了血流阻斷術比照無血流阻斷術應用於肝臟切除手術中的安全性和有效性。本次文獻回顧包括5個隨機臨床試驗。所有試驗具有較高的誤差風險 (‘系統誤差’)。 這5次試驗一共隨機挑選331位病人血流阻斷術組(n = 166) 對照無血流阻斷術組(n = 165) 。資料統計分析指出,間歇性血流阻斷術操作安全,降低手術過程中的出血量。試驗顯示在死亡率和肝衰竭等方面沒有顯著差異,但是由於資料稀少,我們需要實施更多的隨機試驗。