Pringle Maneuver in Extended Liver Resection: A propensity score analysis
Pringle Maneuver in Extended Liver Resection: A propensity score analysis
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DOI：
10.1038/s41598-020-64596-y
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发表时间：
2020-06-01
影响因子：
4.6
通讯作者：
Mehrabi, Arianeb
中科院分区：
文献类型：
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作者：
Al-Saeedi, Mohammed;Ghamarnejad, Omid;Mehrabi, Arianeb
尽管持续了几十年的争议，普林格尔手法（PM）仍然经常使用肝胆外科医生在肝切除术。本研究的目的是研究PM对术中失血量、发病率和切除术后出血（PHH）的影响。209例连续患者接受了扩大肝切除术（EH）（>= 5个肝段切除）。使用多变量分析和倾向评分法评价PM与围手术期结局的相关性，以控制混杂因素。50例患者接受了PM，中位持续时间为19分钟。多变量分析显示，术中出血过多的风险（≥ 1500 ml;比值比[OR] 0.27，95%置信区间[CI] 0.10-0.70，p = 0.007），主要发病率（OR 0.41，95%CI 0.18-0.97，p = 0.041）和PHH（OR 0.22，95%CI 0.06-0.79，p = 0.021）在PM组中显著降低。此外，两组之间的3年无复发生存率无显著差异。PM与EH后较低的术中出血、PHH和主要发病风险相关。进行PM不会增加术后肝功能衰竭，也不会影响复发率。因此，在EH中，PM似乎是合理的。
Despite the ongoing decades-long controversy, Pringle maneuver (PM) is still frequently used by hepatobiliary surgeons during hepatectomy. The aim of this study was to investigate the effect of PM on intraoperative blood loss, morbidity, and posthepatectomy hemorrhage (PHH). A series of 209 consecutive patients underwent extended hepatectomy (EH) (>= 5 segment resection). The association of PM with perioperative outcomes was evaluated using multivariate analysis with a propensity score method to control for confounding. Fifty patients underwent PM with a median duration of 19 minutes. Multivariate analysis revealed that risk of excessive intraoperative bleeding (>= 1500 ml; odds ratio [OR] 0.27, 95%-confidence interval [CI] 0.10-0.70, p = 0.007), major morbidity (OR 0.41, 95%-CI 0.18-0.97, p = 0.041), and PHH (OR 0.22, 95%-CI 0.06-0.79, p = 0.021) were significantly lower in PM group after EH. Furthermore, there was no significant difference in 3-year recurrence-free-survival between groups. PM is associated with lower intraoperative bleeding, PHH, and major morbidity risk after EH. Performing PM does not increase posthepatectomy liver failure and does not affect recurrence rate. Therefore, PM seems to be justified in EH.