L’esclusione vascolare nella chirurgia resettiva del fegato

The demonstration that the liver can tolerate prolonged periods of normothermic ischaemia represents one of the most significant developments in liver resection surgery. It has permitted the application of techniques involving the temporary interruption of blood flow to the liver, with the aim of reducing bleeding during resection. This has led to a widening of the range of indications for the excision of lesions with a high risk of bleeding, and a reduction in the number of blood transfusions. This study analysed the results of 125 liver resections, 19 of which involved cirrhotic liver, carried out under conditions of normothermic ischaemia obtained by complete clamping of the hepatic pedicle either alone (112 patients) or together with caval clamping (13 patients). The mean duration of the ischaemia was 39 minutes (7-107). Eighty-two resections (65.6%) were carried out without transfusions; the mean number of units transfused in the other 43 cases (34.4%) was 2.1 +/- 1.3. The postoperative mortality rate was 0.9%; twenty-six patients (20.8%) developed postoperative complications and the incidence of liver failure was 5.6%. Postoperative disturbances of liver function tests were transitory and, in most cases, rapidly resolving.