ABSTRACT
Objective To investigate the scope of application of precise hepatectomy and its value.Methods The clinical data of 112 consecutive patients with liver neoplasm who received hepatectomy at Renji Hospital from November 2006 to March 2009 were retrospectively analyzed.Precise hepatectomy technique was applied to 88 patients(precise group),whereas pringle maneuver was applied to the rest 24 patients(prince group).Patients in precise group had undergone lobectomy,segmentectomy or local resection,while patients in pringle group received segmenteetomy or local resection.The perioperative conditions of patients in the 2 groups were compared via Fisher exact probability and l test.Results No perioperative mortality,hepatic failure,reoperation due to massive hemorrhage or bile leakage was observed.The blood transfusion rate,blood loss,postoperative total bilirubin(Tbil),prothrombin time(PT)were 7%(2/29),220 ml,20 μmol/L,13 seconds in patients who received segmentectomy and local resection in precise group,and were 4%(1/24),210 ml,19μmol/L and 13 seconds in patients who received segmentectomy and local resection in pringle group,with no significant difference(t=0.248,0.263,0.246,P>0.05).The operation time,postoperative white blood cell (WBC)count.alanine aminotransferase(ALT)value and fever incidence were 60 minutes,7.5×10~9/L,66 U/L,10%(3/29)in patients who received segmentectomy and local resection in precise group,and were 15 minutes,14.0×10~9/L,335 U/L and 42%(10/24)in patients who received segmentectomy and local resection in pringle group,with significant difference(t=4.962,4.961,4.959,P<0.05).In precise group,the blood transfusion rate,postoperative WBC count,ALT value.PT and fever incidence were 9%(4/45),8.3×10~9/L,153 U/L,17 seconds and 13%(6/45)in patients who received Iobectomy,and were 12%(5/43),8.2×10~9/L,133 U/L,14 seconds and 14%(6/43)in patients who received segmentectomy or lncal resection,with no significant difference (t=1.652,1.225,1.236,P>0.05);the blood loss,operation time and postoperative Tbil level were 350 ml,250 minutes and 32μmol/L in patients who received lobectomy.and were 240 ml,150 minutes and 21 μmol/L in patients who received segmentectomy or local resection(t=4.915,4.967,4.829,P＜0.05).Conclusions Precise hepatectomy can decrease damage to patients,but it should be applied in selected patients according to the tumor location and the excision range.Precise hepatectomy is recommended to be applied in lobeetomy.