ObjectiveTo summarize clinical applications of inferior right hepatic vein (IRHV) in liver surgery and to provide a basis for clinical applications of IRHV.MethodThe relevant literatures about clinical applications of IRHV in liver surgery in recent years were reviewed.ResultsAs a kind of short hepatic veins, the IRHV directly flowed into the inferior vena cava, often accompanied by the portal vein of the segment Ⅵ. The occurrence rate of IRHV was 80%–90% by the autopsy examination, while which was 10%–30% by the imaging examination. The caliber of IRHV was 0.22–0.95 cm, and its caliber was negatively correlated with the caliber of right hepatic vein. The IRHV played a great role in the classification and treatment of the Budd-Chiari syndrome. According to the Couinaud liver classification method, the IRHV mainly drained the blood of segment Ⅵ. The existence of IRHV expanded the indications of hepatectomy. The reconstruction of IRHV in the liver transplantation could not only reserve the function of donor liver, but could compensatively drain the corresponding liver areas if the acute occlusion of other major hepatic veins happened.ConclusionsIRHV has some important clinical significances in liver surgery. Fully studying course characters and adjacent relationship of IRHV can not only avoid injury during surgery, but also provide a new treatment idea for related liver diseases.
ObjectiveTo explore it's advantages and disadvantages through analyzed the data of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) operation in 3 cases of liver cancer patients with cirrhosis. MethodsThe data of 3 patients perfomed ALPPS operation were retrospectively analyzed, through the preoperative evaluation, intraoperative and postoperative treatment points analyzed to explore the pros and cons. ResultsOne case died of hepatic failure, and the remaining two cases were still alive. The highest score of MELD of liver failure in death case was 18.8 scores, and the other cases of MELD score were decreased after second operation. The average increased volume of liver was 225 mL, and the liver volume was significantly increased (P=0.002). ConclusionsALPPS make a portion of huge liver cancer patients combining with cirrhosis having a chance to surgery. But it is necessary to consider in patients with preoperative state, surgical risk, prognosis and economic conditions,in order to determine whether patients can benefit from ALPPS.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.MethodsThe clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.ResultsTwo cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.
ObjectiveTo systematically evaluate the risk factors for posthepatectomy liver failure (PHLF) of hepatobiliary malignancies in order to provide evidence-based medical basis for preventing and reducing PHLF.MethodsThe case-control studies on the risk factors of PHLF for hepatobiliary malignancy were searched in PubMed, CNKI, etc. domestic and foreign databases from January 2011 to March 2020. The quality evaluation of the literatures was performed by using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3.ResultsA total of 43 studies were included, involving 13 075 patients after hepatectomy, of which 1 943 (14.86%) had PHLF. Meta-analysis results showed that the male, liver cirrhosis, portal hypertension, hepatectomy range ≥3 segments, vascular tumor thrombus, intraoperative blood transfusion, tumor number ≥2, Child-Pugh grade ≥B, less platelet count, lower albumin, higher total bilirubin, higer indocyanine green retention rate at 15 minutes, longer hepatic hilar occlusion time, longer operation time, more intraoperative blood loss, bigger maximum tumor diameter, smaller residual liver volume, and higer MELD score were the risk factors for the occurrence of PHLF (P<0.05).ConclusionsAccording to the risk factors of PHLF, the basic condition, liver function, and residual liver volume should be fully evaluated before operation. The operation should be accurate anatomy, adequate hemostasis, timely treatment of intraoperative complications. After operation, the fluid infusion, anti-infection, correction of coagulation dysfunction, and protection of liver function should be strengthened. So incidence of PHLF might be reduced minimally.
Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
ObjectiveTo compare the efficacy and safety of three different modes of blood flow blocking in hepatectomy for primary hepatocellular carcinoma.MethodsThe clinical data of 152 patients with primary hepatocellular carcinoma who underwent hepatectomy and postoperative pathology examination in our department in recent 3 years (2017–2020) were retrospectively analyzed. According to the modes of intraoperative hepatic blood flow occlusion, the patients were divided into three groups: intermittent Pringle method (IPM) group (41 cases), IPM was applied only; hemihepatic group (35 cases), hemihepatic blood flow blocking method was used only; and combined group (76 cases), combined hemihepatic blood flow blocking method and IPM. SPSS software was used to compare the differences of the three groups’ general data, intraoperative blood loss and postoperative liver function indexes. The changes of transaminase levels in the three groups were observed dynamically.ResultsBaseline data of the three groups were not statistically significant (P>0.05). There were no statistically significant differences in operative time, the number of resected liver segments, blood transfusion rate, incidence of complications, and postoperative length of stay among the three groups (all P>0.05). The intraoperative blood loss of the combined group and the IPM group were significantly less than that of the hemihepatic group (P<0.05). There was no difference in blood loss between the combined group and the IPM group (P>0.05). However, the blocking times in the combined group were significantly less than those in the IPM group (P<0.05). The transaminases in the three groups were close to the preoperative level on the fifth day after operation. Conclusions In hepatectomy of primary hepatocellular carcinoma, the three blocking modes are safe and effective. The combined application of hemihepatic blood flow blocking method and intermittent Pringle method can significantly reduce intraoperative blood loss, reduce the number of blocking, and do not aggravate the liver function injury.
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.