Objective To investigate the technique and feasibility of hepatic pedicle vascular control in laparoscopic hepatectomy. Methods From May 2005 to June 2011, 95 cases of hepatectomies were performed by laparoscopy in the Department of Minimally Invasive Surgery, The First Affiliated Hospital, Guangxi Medical University.The characteristics of these cases were analyzed. Results Left lateral segmentectomy were required in 21 patients, left hepatectomy in 13 patients, right hepatectomy in 4 patients, segmentectomy in 17 patients, tumor resection in 24 patients,hemangioma resection in 5 patients, and conversions to laparotomy in 11 patients. The intermittent Pringle maneuver were performed in 39 patients. The mean vascular clamping time in Pringle maneuver was （30.84±9.51） min. The selective vascular control of inflow were performed in 56 patients， the technique included intrahepatic Glisson approach in 14 patients and controlling hepatic artery and portal vein separately in 42 patients. Pre-parenchymal transection control of hepatic outflow were performed in 12 patients, included the left hepatic vein were controlled by suturing or separating in 11 patients and right hepatic vein was controlled by separating in 1 patient. Others were controlled intraparenchymally during transection. The mean operative time was （236.80±95.97） min，mean operative blood loss was（ 551.55±497.41） ml， concentrate red blood cells transfusion volume was（ 2.60±2.23） U， and plasma transfusion volume was （211.90±179.29） ml. The postoperative complications included bleeding in 4 patients, pleural effusion in 4 patients, pneumonia in 3 patients, ascites in 7 patients, and biliary fistula in 2 patients, and dead in 1 patient. The mean hospitalization time was（ 12.47±4.18） days. At the deadline（ February 2012）, 72 cases with liver cancer were followup. The follow-up time ranged from 5 to 81 months and the mean time was（ 24.14±16.62） months， where survival rate was 68.4%（ 54/79） of 1-year and 21.5%（ 17/79） of 3-year. Conclusions The application of hepatic pedicle vascular control in laparoscopic hepatectomy is feasible.
Objective To evaluate different clinical effects of three inflow occlusion methods in hepatectomy including pringle maneuver （Pringle group），selective portal venous exclusion （SPVE group）， and Glissonean pedicle exclusion （SGSE group）. Methods The clinical data of patients underwent the liver resection with the above liver inflow occlusion methods were retrospectively analyzed. The operation time， inflow occlusion time， amount of intraop-erative blood loss， transfusion rate， and postoperative hepatic function and complication rate were compared for each group. Results There were not significant difference of preoperative conditions，operation time， inflow occlusion time，tumor character， postoperative liver function， hospital time，and ICU time （P＞0.05）. The amount of intraoperative blood loss and rate of blood transfusion of SGSE group were significantly less （lower） than those Pringle group and SPVEgroup （P＜0.05）. In addition to the first day after operation， the AST and ALT at other time point of SPVE group and SGSE group were improved than that Pringle group （P＜0.05）， while TBIL at the third and fifth day after operation ofPringle group were improved （P＜0.05）. The complication rates of SPVE group and SGSE group were significantly lowerthan that of Pringle group （P＜0.05）. Conclusions In the similar operatin time and inflow occlusion time，Glissonean pedicle exclusion method can control the intraoperative blood loss and blood transfusion better，and can promote the patientrecovery. Besides， the inflow occlusion methods should be selected based on the practical condition of patients.
ObjectiveTo investigate the correlation between perioperative blood transfusion and hepatic postoperative infection. MethodsOne hundred and thirty patients undergoing hepatic operation were analyzed retrospectively on the relation of perioperative blood transfusion with postoperative infective morbidity and mortality in the period 1989-1999. The patients were divided into blood transfused group and nontransfused group. The major or minor hepatectomy was performed in 53 patients with hepatic malignancy and benign diseases. ResultsIn the blood transfused group, the infective morbidity and perioperative mortality rate was 38.5% and 16.7% respectively, significantly higher than those in nontransfused group (11.5% and 3.8% respectively), P＜0.05. The total lymphocyte count was lower in transfused group than that in nontransfused group. The postoperative antibiotics used time and length of hospital stay were (9.7±4.2) days and (18.7±13.1) days respectively in transfused group than those in nontransfused group (5.3±2.3) days and (12.7±5.2) days respectively. ConclusionThe results suggest that hepatic postoperative infective morbidity and mortality are related with perioperative blood transfusion. Any strategy to reduce blood loss in liver surgery and decrease blood transfusion would be helpful to lower postoperative infective morbidity.
ObjectiveTo summarize the experiences of precise liver resection for giant complex hepatic neoplasm. MethodsFifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009. Hepatic functional reserve and liver imaging were evaluated before operation. Appropriate surgical approach, halfhepatic blood flow occlusion, new technique of liver resection, and intraoperative ultrasonography were applied during operation. ResultsThe mean operative time, halfhepatic blood occlusion time, blood loss, recovery of alanine aminotransferase, and total bilirubin were 350 min (210－440 min), 43 min (8－57 min), 370 ml (250－1 150 ml), 10 d (7－14 d), and 4.5 d (3－10 d), respectively. Only 6 patients had mild bile leakage. No liver failure and other major complications emerged, and no death happened. ConclusionPrecise liver resection is a safe and effective approach for giant complex hepatic neoplasm.
ObjectiveTo investigate the effect of intermittent Pringle (IP) and continuous hemi-hepatic vascular inflow occlusion (CHVIO) on the prognosis of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis in laparoscopic liver resection (LLR).MethodsRetrospective analysis of consecutive 107 LLR patients with HCC complicated with liver cirrhosis at West China Hospital of Sichuan University between January 2015 and December 2017 was performed. Patients were divided into an IP group and a CHVIO group according to the method of hepatic vascular occlusion, intraoperative and postoperative outcome indicators and short-term prognosis were compared between the two groups.ResultsPatients in the IP group had shorter operative time [(237+90) min vs (285+118) min, P=0.041] and less blood loss [(279+24) mL vs (396+35) mL, P=0.012], without a significant increase in postoperative liver function [including ALT, AST, TBIL, and ALB], postoperative complications, induced flow, 1-year disease-free survival, and1-year survival (P>0.05).ConclusionsIP can reduce the operative time and blood loss in patients with HCC complicated with cirrhosis in LLR, and will not lead to deterioration of liver function, it is a recommended hepatic inflowocclusion method.
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 investigate whether protease inhibitor (ulinastatin, UTI) can protect liver from ischemiareperfusion injury in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after hepatic inflow occlusion. Methods A prospective randomized control study was designed. Thirtyone HCC patients undergoing hepatectomy after hepatic inflow blood occlusion were randomly divided into the following two groups. UTI group (n=16)， 1×105 units of ulinastatin was given intravenously in operation, then the dosage was continuously used twice a day up to 5 days postoperatively. Control group (n=15), the patients received other liver protective drugs. Liver function, plasma C-reactive protein (CRP) and cortisol level were compared between these two groups. Results The postoperative liver function of the UTI group was significantly improved compared with the control group. For example, on the third postoperative day the aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin level in the UTI group were significantly lower than those in the control group, respectively (P＜0.05). On the first postoperative day, the plasma CRP concentration in the UTI group was significantly lower than that in the control group(P＜0.01). The plasma cortisol level in the control group markedly increased compared with the level before operation(P=0.046). However, there was no significant difference in the UTI group between before and after operation. Conclusion Ulinastatin can effectively protect liver from ischemia/reperfusion injury in HCC patients undergoing hepatectomy performed after hepatic inflow occlusion. Also, it can relieve the surgical stress for patients.
ObjectiveTo investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.MethodsThe clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were grouped according to different surgical procedures, 21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group, and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group. The operation time, intraoperative bleeding volume, postoperative hospital stays, liver function recovery, and postoperative complications were compared between the two groups.ResultsThere was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time (P>0.05), but the postoperative hospital stays in the observation group shortened (P=0.025). The changes on the ALT, TB, and AST in the observation group was obvious than those of the control group (P<0.05). There was no statistically significant incidence between the two groups in the total incidence of complications (P=0.128).ConclusionsCompared with Pringle method of total hepatic vascular exclusion, descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers, and it is convenient to implement hemihepatic blood flow occlusion. It has less damage to healthy side of the liver and quicker liver function recovery, and it can reduce postoperative complications and shorten postoperative hospital stay.
目的探讨肝血管瘤切除术中血流阻断方法的选择。方法回顾性分析我院收治的19例肝血管瘤患者的手术方式。结果全组均行手术切除，术中出血50～1 500 ml（平均312 ml）。 术中根据血管瘤所在位置选择不同肝血流阻断方法，其中行半肝血流阻断4例，运用Glisson蒂横断式肝切除术或其分段原理阻断Glisson系统分支6例，间断阻断第一肝门7例，预置肝上、下下腔静脉和第一肝门阻断带并间断阻断第一肝门2例。 术后5例并发右侧胸腔积液，均经保守治疗后好转，手术并发症发生率为26.3%（5/19）。 术后住院7～41 d（平均16.9 d），均治愈出院。12例患者获随访，随访0.3～2年（平均1.1年），术前有症状的8例患者症状均消失，无复发，1例残留肝内血管瘤（直径lt;2 cm）。结论肝血管瘤患者肝切除术中的入肝血流阻断应强调个体化，根据肿瘤位置及大小选择不同的阻断方法，使患者术中出血少，术后恢复快。
目的探讨腹腔镜下不同的入肝血流阻断方法下行规则性或不规则性局部肝切除的手术方法及其临床应用。 方法回顾性分析2007年5月至2012年7月期间在江苏省苏北人民医院完成的25例腹腔镜肝切除术患者的临床资料，其中行规则性肝切除术14例，不规则性局部肝切除术11例。术后病理学检查证实原发性肝癌9例，肝血管瘤10例，结直肠癌肝转移1例，左肝内胆管结石5例。 结果本组25例均成功完成了腹腔镜肝切除术（其中合并胆囊切除术3例，合并胆囊切除及胆总管探查术1例），无中转开腹手术者。其中行区域性入肝血流阻断联合规则性肝切除术14例，应用自制的第一肝门阻断器行全肝入肝血流阻断联合不规则的局部肝切除术11例。手术时间（149.6±19.8）min（120～195 min），术中出血量（320±73.6）mL（180～460 mL），腹腔引流管放置时间3～11 d。有1例术后第3天出现胆汁漏，予以放置自制双套管冲洗后引流量逐渐减少，术后第11天顺利拔管；其余病例未发生胆汁漏、出血、感染等并发症。术后住院时间（8.6±2.4）d（5～13 d）。9例肝脏恶性肿瘤患者术后均获随访，截至2012年7月29日，其随访时间12～48个月，平均17个月，1年无瘤生存患者有7例。 结论腹腔镜肝切除术是安全可行的，肝脏血流阻断技术是其成功的关键和保障。左半肝或左外叶病灶可考虑行区域性入肝血流阻断联合规则性肝切除术；右半肝不规则的病灶或病灶较小时，应用自制的第一肝门阻断器行全肝入肝血流阻断联合不规则的局部肝切除术，是简洁、实用的方法，可避免切除过多的肝组织。