Abstract
BACKGROUND
Reducing bleeding in hepatectomy is beneficial to patient prognosis. Restricted fluid infusion based on the low central venous pressure (LCVP) concept is often advocated in hepatectomy to reduce intraoperative bleeding, but its safety and efficacy are controversial. Acute hypervolemic hemodilution (AHH) is used for blood protection in a variety of procedures, its use in liver surgery has not been reported in the literature. This study aims to investigate the effect of LCVP-guided restrictive infusion and AHH on intraoperative bleeding in hepatectomy.
METHODS
This historical cohort study collected data from 358 patients who underwent hepatectomy at West China Hospital of Sichuan University from July 2017 to November 2022, and classified them into the fluid restriction group (group L) and AHH group (group A) according to the different perioperative fluid management strategy. To determine if the two groups differed in intraoperative bleeding, postoperative alterations of biochemical indicators, and the occurrence of pulmonary complications.
RESULTS
358 patients were enrolled according to inclusive and exclusive criteria, including 143 patients in group L and 215 in group A. There was no difference between the two groups in intraoperative bleeding, blood transfusion rate, postoperative hospital stay, intraoperative infusion, the incidence of postoperative pleural effusion and pulmonary infection, coagulation indicator, liver and kidney function-related indicators. However, intraoperative urine decreased by 22.2 mL/h in group L compared to group A (P = 0.003), the norepinephrine use rate was 21.0% in group L and 8.8% in group A (P = 0.001), the albumin loss decreased by 1.4 g/L in group L compared to group A (P = 0.01).
CONCLUSION
There was no difference between the effect of AHH and LCVP-guided restrictive infusion strategy on intraoperative bleeding in hepatectomy, and the use of AHH was associated with an increase in intraoperative urinary output and a decrease in norepinephrine use rate. This study overthrows the previous idea that fluid infusion must be restricted during hepatectomy and provides a new idea for fluid management strategy, which is helpful for circulation management during partial hepatectomy.