HEMORRHAGE PREVENTION AND COMPENSATION IN HEPATIC RESECTION SURGERY

Aim. To improve the results of surgery in patients with focal hepatic diseases using rational surgical tactics, purposeful transfusion therapy and effective hemostatic means. Materials and methods. During the period from 1995 to 2003, 398 patients with focal hepatic diseases were treated. 257 patients (64,6%) underwent hepatic resection including 98 (38,1%) – large hepatic resections (3 segments), 159 (61,9%) – minor hepatic resections. Patients were divided into two groups – the main group ( n =137) and the comparison group ( n =120). In the main group, 54 (39,4%) patients underwent large resections, 83 (60,6%) – minor ones. In the comparison group, 44 (36,7%) had large hepatic resections, 76 (63,3%) – minor ones. In the main group the following means were applied: preoperative autoblood reservation, principle of operation from the vessels, hepatic tissue dissection by means of ultrasonic destructor-aspirator and harmonic Ultracision «Johnson&Johnson» scalpel, Pringle manoeuvre, argonoplasmic coagulation of resected hepatic stump surface, local hemostatic means. In the comparison group, hepatic-duodenal ligament compression, isolation of vasculosecretory elements by resection line using digitoclasy, hepatic stump suturing was used by indications so as to prevent hemorrhage. Results. The volume of intraoperative hemorrhage in the main group reached 1100±20 ml, in the comparison group – 2700±250 ml ( p <0,001). The average number of transfused doses of allogenic blood in the main group was 2,1±0,3, in the comparison group – 12,5±1,3 ( p <0,001). The average volume of previously prepared transfused autoblood in the main group was 0,83±0,1 dose, in the comparison group it was not used. After preoperative autoblood reservation was included into the program, the average volume of transfused allogenic blood decreased from 11,1±1,6 to 1,5±1,1 doses ( p <0,001) in case of large hepatic resections and from 3,6±1,1 doses to 0 – in minor resections ( p <0,001). The postoperative lethality in the main group was 2,2% ( n =3), in the comparison group – 9,2% ( n =11). Conclusion. Introduction of modern equipment into surgical practice for the purpose of performing hepatic parenchyma dissection permits to reduce the volume of hemorrhage and the number of doses of infused donor erythromass. Local hemostatic means applied decrease the risk of developing hemorrhage and biliary excretion from the wound surface of hepatic stump in the postoperative period. The developed system of intraoperative and perioperative safety in hepatic resection surgery allows to reduce the risk of operative intervention, to lower the number of postoperative complications.

Focal hepatic diseases, hepatic resection, hemorrhage prevention, postoperative complications