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.
目的 探讨白试验在肝切除手术中检测漏胆的价值。方法 笔者所在医院2008年1月至2013年1月期间在肝切除手术中采用白试验联合干纱布擦拭法检测漏胆56例。即在肝切除手术操作末期，用干纱布擦拭法确认无漏胆后，经胆囊管或左右肝管插管注入5%无菌脂肪乳剂10～30mL，同时用手阻断远端胆总管。观察肝切除手术创面的白色液体渗出情况，对渗出白色液体处予以间断缝合。重复操作，至断面无白色液体渗出为止。结果 56例患者经术中检测，发现漏胆17例（漏胆检出率为30.4%），每例发现漏胆1～6处（平均2.9处），术中均予以确切缝合以关闭漏胆处，且重复试验操作，证实均再无漏胆。术后发生漏胆2例（3.6%），经相应治疗后痊愈出院。全部患者出院后均随访3～6个月（平均3.8个月），无膈下积液或膈下感染病例发生。结论 术中白试验能够发现漏胆的精确部位，不会污染肝切除手术创面，并能够无限次地重复试验，值得临床推广。
目的 探讨原发性肝癌自发性破裂腹腔内出血的临床特点和手术治疗方法。方法 回顾性分析我院1998～2007年收治的53例经手术证实的原发性肝癌自发性破裂腹腔内出血患者的临床资料，结合文献复习进行讨论。结果 53例患者均以突发性腹痛为首发症状，有前期症状者33例，无症状者20例； 有外伤史者(左上腹或季肋区)6例； 有腹膜炎体征46例，腹腔穿刺抽出不凝血41例，合并休克29例。术前误诊16例。行急诊手术48例，施行肝切除33例。术后肝功能不全34例，其中3例死于肝功能衰竭。术后生存3 d～78个月，平均34.6个月。结论 原发性肝癌自发性破裂腹腔内出血多以腹痛为首发，常以血性腹膜炎表现为特点，术前误诊率较高； 手术方式根据病变位置、大小，肿瘤是否局限、转移和肝硬变程度决定。术后近期死亡原因主要是肝功能衰竭，远期死亡原因主要是复发转移。
Bile leakage is a common complication of hepatocellular carcinoma (HCC) after hepatectomy, which affects the prognosis and medical quality. It is emphasized that taking preventive measures according to the etiology and related risk factors could help to reduce the incidence of bile leakage, improve the quality and safety of HCC diagnosis and treatment, and achieve the main indicators of HCC quality control in the 2022 version of National Cancer Center. In this review, combined with the team of Peng’s leakage test technology research and clinical practice, brief talk about personal experience.
【Abstract】ObjectiveTo investigate the perioperative management in hepatectomy using hepatic energy metabolisom for enhancing safety of and improving the survival in patients with primary liver cancer (PLC).MethodsTwo thousands and one hundred fortythree patients with PLC were treated in this hospital from January 1990 to January 2004. The perioperative data, operative approach, postoperative treatment, postoperative clinical course and follow up data were retrospectively analyzed. All patients were divided into two groups: the early period group and the late period group(from January 1997 to January 2004) and comparison was taken between two groups. The preoperative redox tolerance index (RTI), intraoperative hepatopetal blood occlusion of half liver, and postoperative arterial ketone body ratio (AKBR) were investigated and evaluated.Results①The proportion of small PLC and resection rate increased, the morbidity of complications and mortality after hepatectomy decreased, also the survival rate prolonged in the late period group. ②When using RTI as an indicator for selection of hepatectomy, the morbidity of complications decreased from 21.1% to 11.0%, the mortality form 1.6% to 0.3%. ③Comparising hepatopetal blood occlusion of total liver (n=476) with half liver (n=523),the postoperative morbidity of complications and mortality were 25.8% to 11.9% and 2.3% to 0.6% respectively. ④Postoperative AKBR measurements was a reliable indicator to assess the energy status of the liver and liver failure.ConclusionRTI is of potential value in predicting preoperative hepatic functional reserve, hepatopetal blood occlusion of half liver could protect the residual liver function, and postoperative AKBR measuremeant is a simple and accurate means of determining the immediate state of metabolic dysfunctioning in liver resection. The authors propose that perioperative treatment is an important factor in decreasing operative complications and mortality rate after liver resection.
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.
ObjectiveTo summarize recent researches on mechanism of the hepatic ischemic preconditioning (IPC) and its clinical applications on hepatectomy and liver transplantation. MethodsRelevant references about basic and clinical researches of hepatic IPC were collected and reviewed. ResultsRecent experimental researches indicated that IPC could relieve hepatic ischemiareperfusion injury (IRI) by remaining and improving energy metabolism of liver, regulating microcirculation disorder, decreasing the production of lipid peroxidation and oxyradical. It could also inhibit the activation of inflammatory cells and the release of cytokine, suppress cell apoptosis and induce the release of endogenous protective substance. Till now, most of the clinical researches had confirmed the protective function of hepatic IPC, but there were still some references with opposite opinions. ConclusionHepatic IPC could relieve liver IRI, but its clinical application value on hepatectomy and liver transplantation still need more researches to prove.