ABSTRACT
Objective:To investigate the clinical value of indocyanine green (ICG) staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach in the treament of liver cancer.Methods:The clinical data of 150 patients with primary liver cancer, who received treatment in Yuyao People's Hospital from January 2019 to December 2020, were retrospectively analyzed. Group A ( n = 82) and group B ( n = 68) were designated according to the surgery methods used. The group A was subject to laparoscopic hepatectomy with a Glisson pedicle approach. The group B received ICG staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach. Operation-related conditions, postoperative complications, and the change in liver function indexes after surgery relative to before surgery were compared between the two groups. Results:There were no significant differences in the time taken to first anal exhaust, extubation time, and length of hospital stay between group A and group B (all P > 0.05). Operative time and intraoperative bleeding in the group B were (205.04 ± 35.01) minutes and (230.05 ± 17.53) mL, respectively, which were significantly lower than those in the group A [(228.07 ± 28.05) minutes, (255.07 ± 19.00) mL, t = 4.47, 8.31, both P < 0.05]. R0 resection rate was significantly lower in group B than in group A [85.29% (58/68) vs. 70.73% (58/82), χ2 = 4.50, P < 0.05]. There were no significant differences in postoperative complications between the two groups ( P > 0.05). Before treatment, there were no significant differences in serum levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and total bilirubin between the two groups (all P > 0.05). At 1 day after surgery, serum ALT, AST, and TBil levels in each group were significantly increased compared with before surgery (all P < 0.05). Furthermore, serum levels of ALT, AST and TBil in the group A were (108.51 ± 30.23) U/L, (107.66 ± 26.93) U/L, and (32.16 ± 4.73) μmol/L, respectively, which were significantly higher than those in the group B [(88.38 ± 24.76) U/L, (86.85 ± 19.74) U/L, (27.95 ± 4.31) μmol/L, t = 4.40, 5.30, 5.65, all P < 0.05]. At 3 days after surgery, serum levels of ALT, AST, and TBil in each group were significantly lower than those at 1 day after surgery, but they were still higher than those before surgery. At 3 days after surgery, serum levels of ALT, AST and TBil in group A were (74.20 ± 13.83) U/L, (65.22 ± 9.68) U/L, and (28.18 ± 4.14) μmol/L, respectively, which were significantly higher than those in group B [(54.72 ± 10.31) U/L, (55.41 ± 7.63) U/L, (24.25 ± 3.98) μmol/L, t = 9.61, 6.79, 5.89, all P < 0.05]. Conclusion:Although the ICG staining technique has certain limitations, it can improve the accuracy of hepatectomy to a certain extent. ICG staining technique combined with laparoscopic hepatectomy with the Glisson pedicle approach is a safe and accurate treatment for liver cancer. The combined therapy is worthy of clinical application.
ABSTRACT
Objective:To investigate the application value of extrathecal Glisson blood flow occlusion in the resection of primary liver cancer.Methods:74 patients with primary liver cancer who received treatment in Yuyao People's Hospital from January 2019 to January 2020 were included in this study. They were randomly assigned to undergo resection of the primary liver cancer with either extracorporeal Pringle maneuver (control group, n = 37) or extrathecal Glisson maneuver (observation group, n = 37). Surgery-related indexes, postoperative liver function and gastrointestinal function recovery, and complications were monitored in each group. Results:Blood flow occlusion time and hospital length of stay in the observation group were (25.10 ± 5.19) minutes and (12.45 ± 1.10) days, which were significantly shorter than those in the control group [(30.65 ± 8.54) minutes, (14.85 ± 1.28) days, t = 3.378, 8.650, both P < 0.05]. Volume of blood loss in the observation group was significantly less than that in the control group [(490.36 ± 120.19) mL vs. (655.58 ± 152.24) mL, t = 5.181, P < 0.05]. Intraoperative blood transfusion rate in the observation group was significantly lower than that in the control group [21.62% (8/37) vs. 45.95% (17/37), χ2 = 4.893, P < 0.05]. At 1, 3 and 7 days after surgery, aspartate aminotransferase level in the observation group was (240.36 ± 60.52) U/L, (145.69 ± 42.18) U/L and (60.13 ± 12.58) U/L, respectively, which was significantly lower than that in the control group [(350.21 ± 60.16) U/L, (212.53 ± 40.21) U/L, (103.65 ± 20.54) U/L, t = 7.930, 6.977 and 10.991, all P < 0.05]. At 1 and 7 days after surgery, alanine aminotransferase level in the observation group was (228.52 ± 65.28) U/L and (44.26 ± 12.85) U/L, respectively, which was significantly lower than that in the control group [(350.16 ± 68.58) U/L, (466.36 ± 40.29) U/L, t = 7.815 and 3.179, both P < 0.05]. At 1 and 7 days after surgery, total bilirubin level in the observation group was (28.58 ± 5.24) μmol/L and (20.30 ± 5.10) μmol/L, which was significantly lower than that in the control group [(43.32 ± 10.26) μmol/L, (26.08 ± 5.68) μmol/L, t = 7.783, 4.606, both P < 0.05]. At 1 day after surgery, albumin level in the observation group was significantly lower than that in the control group [(34.65 ± 2.42) g/L vs. (31.12 ± 2.23) g/L, t = 6.525, P < 0.05). The time to recovery of bowel sounds, the time to the first exhaust, and the time to defecation in the observation group were (14.28 ± 2.10) hours, (29.21 ± 5.10) hours, and (54.20 ± 5.69) hours, which were significantly shorter than those in the control group [(16.65 ± 2.16) hours, (33.25 ± 5.47) hours, (59.85 ± 5.87) hours, t = 4.783, 3.286 and 4.204, all P < 0.05]. The total incidence of postoperative complications in the observation group was significantly lower than that in the control group [13.51% (5/37) vs. 35.14% (13/37), χ2 = 4.698, P < 0.05]. Conclusion:Extrathecal Glisson maneuver for the resection of primary liver cancer exhibits better performance in the control of bleeding, reduction of postoperative complications, and acceleration of rehabilitation than extracorporeal Pringle maneuver.