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Acting as a difficult and high risk procedure in the operation, laparoscopic central tumor anatomical hepatectomy possesses various technical points that shall be noted in the process of application. The choice of laparoscopic approach has been recognized to be one of the key technical links for this technique. According to the anatomical characteristics of the middle lobe of liver and "Easy first" strategy, the authors summarize the laparoscopic central tumor anatomical hepatectomy technology with left side hepatic parenchymal transection-first approach. The left side hepatic parenchymal transection-first approach is found to be simple, fast, safe and effective in operation, which overcomes the challenges of complicated target Glisson pedicle operation and high technical risk of laparoscopic anatomical hepatectomy. The approach also better complies with the "no-touch" principle for malignant tumors. Significantly, it exhibits clinical application value in laparoscopic central tumor anatomical hepatectomy.
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Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.
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Objective:To assess the safety and feasibility of hepatic pedicle-first approach laparoscopic anatomical hepatectomy for central segments.Methods:The clinical data of 19 patients with hepatocellular carcinoma who underwent hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments in the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from September 2020 to January 2023 were retrospectively analyzed. In this procedure, hepatic pedicles of the central segments were divided first to delineate the ischemic demarcation and guide the liver parenchymal transection. The methods of operation, operation time, intraoperative blood loss, postoperative complications and hospital-stay were analyzed.Results:Hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments was successfully performed in all patients, including 5 cases of segment Ⅳ, 2 cases of segment Ⅳ+ Ⅷ, 3 cases of segment Ⅳ+ ventral segment Ⅷ, 3 cases of segment Ⅳa+ Ⅴ+ Ⅷ and 6 cases of segment Ⅴ+ Ⅷ. The mean operation time, intraoperative blood loss and postoperative hospital stay was (253.1±86.1) min, [ M( Q1, Q3)] 100.0(100.0, 250.0) ml, and (5.1±1.2) d respectively. There was no intraoperative blood transfusion and postoperative complications. Conclusion:Hepatic pedicle-first approach can help delineate the segemental demarcation in laparoscopic anatomical hepatectomy for the central segments, which is technically feasible and worth more practice.
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The clinical data of patients with hepatocellular carcinoma who underwent anatomical hepatectomy at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from June 2021 to January 2022 were retrospectively analyzed. Of 4 patients, there were 3 males and 1 female, aged (52.0±3.7) years. These patient underwent anatomical hepatectomy using the " target territory hepatic artery dye-injection" method. There were 2 patients with right hemi liver tumors with portal vein tumor thrombus, and 1 patient with a right anterior section tumor which involved the ventral segment of right anterior branch of portal vein. One patient had a left hemi liver tumor with portal vein tumor thrombus. The surgical operations were right hemihepatectomy combined with thrombectomy of portal vein in 2 patients, right anterior sectionectomy in 1 patient, and left hemihepatectomy combined with thrombectomy of portal vein in 1 patient. There were no postoperative complications including bile fistula or bleeding. The "Target territory hepatic artery dye-injection" method could be used in appropriate by selected patients.
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Laparoscopic anatomic hepatectomy has become one of the therapeutic measures for hepatocellular carcinoma (HCC), which has been proven to bring both minimally invasive and survival benefits to patients from both surgical and oncological perspectives. More than 80% of HCC patients in China are complicated with cirrhosis, and the liver reserve function is impaired. Tumors often grow across liver segments or involve multiple segments. However, the application of tradi-tional laparoscopic anatomic hepatectomy is limited due to the large volume of liver resection, which is prone to lead to postoperative liver failure. Based on the bio-oncological characteristics of HCC and the limitations of traditional laparoscopic anatomical hepatectomy, the concept and practice of laparoscopic limited anatomical hepatectomy (LLAH) came into being. LLAH, also known as hepatic parenchyma-preserving anatomical hepatectomy, is based on the tumor lesion as the center, the portal territory with tumor as the reference plane, and anatomical relationship between tumor location and the sub-hepatic segment or hepatic segment as the principle to remove the tumor and its subsegment or hepatic segmental portal territory. Its core concept is to maximize the preser-vation of functional liver parenchyma on the premise of ensuring oncological resection. The main surgical procedures of LLAH include anatomical subsegmental resection, segmentectomy and combined subsegmental/segmental resection with preservation of liver parenchyma. Its main indica-tion is small or micro hepatocellular carcinoma located between subsegments/segments. Navigation technologies such as three-dimensional visualization, laparo-scopic ultrasound, and indocyanine green fusion fluorescence are used to achieve anatomical hepatectomy with tumor and its oncolo-gical safety margin as the center through the splicing and combination of multiple subsegments/segments. The purpose of resection of the liver tissue in the portal territory with tumor and preser-vation of the functional liver structure and volume are achieved to the maximum extent after LLAH. At present, LLAH for HCC is still in the exploratory stage, and its long-term oncology results need to be further studied. However, with technological progress and concept update, LLAH will surely become the core method for minimally invasive and precise treatment of HCC. Combined with related researches at at home and abroad, the authors describe the concept and development, theoretical and technical supports, oncological safety and development trends of LLAH.
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Objective:To formulate surgical strategies and guide the implementation of laparoscopic anatomical hepatectomy with preoperative simulative resection.Methods:Twenty-two cases of hepatocellular carcinoma undergoing laparoscopic lobe, segment, subsegment and combined segment liver resection following preoperative simulative resection from Sep 2020 to Jan 2022 were enrolled in this study retrospectively.We observed and analyzed the operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication.Results:All patients underwent laparoscopic hepatectomy successfully according to the preoperative simulative resection plan without conversion, some of them adjusted plan according to preoperative simulative resection. The median operation time was 170.0 min, the median intraoperative blood loss was 150.0 ml, the median times of pringle maneuver was done on 4 episodes, and the median postoperative hospital stay was 6.5 days. There were no severe postoperative complications in all cases.Conclusion:Preoperative simulative resection can plan the range of surgical resection accurately by visualizing important anatomical structures,greatly helping the actual surgical hepatectomy.
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In recent years, the existence of the Laennec′s capsule has been histologically confirmed and contributes to the Laennec′s approach based on Laennec′s capsule for anatomic hepatectomy. With the deep understanding of liver surgery, the importance of Laennec′s approach based on Laennec′s capsule could be recognized. Better use of Laennec′s capsule would be beneficial to the standardization of surgical technique, facilitate safe and precise anatomical liver resection.The application of Laennec′s capsule in hepatic inflow occlusion and intrahepatic segmentation was summarized in this study. The natural gap between Laennec′s capsule, the liver pedicle and hepatic veins can reduce the destruction of liver parenchyma and intraoperative hemorrhage, simplify surgical steps, shorten the time of Hilar occlusion and surgery.
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Objective@#To study the clinical outcomes of anatomical hepatectomy combined with intraoperative choledochoscopy in treatment of complicated hepatolithiasis.@*Methods@#The clinical data of 176 patients with complicated hepatolithiasis who underwent operation at the Department of General Surgery of No.960 Hospital of PLA from May 2005 to July 2015 were analyzed retrospectively. The data included general data, clinical manifestations, types of stones, operative methods, postoperative complications and follow-up.@*Results@#There was no perioperative death. The postoperative complications which occurred in 31 patients (17.6%) included lung infection, intra-abdominal infection, bile leakage, and liver failure. Eighteen patients (10.2%) were found to have residual stones. After a follow-up which ranged from 1 to 3 years, 152 patients (94.4%) had good clinical outcomes. Recurrent stones were found in 12 patients (7.5%).@*Conclusion@#Anatomical hepatectomy combined with intraoperative choledochoscopy improved operative outcomes in patients with complicated hepatolithiasis and decreased residual stone and recurrence rates.
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Objective To study the clinical outcomes of anatomical hepatectomy combined withintraoperative choledochoscopy in treatment of complicated hepatolithiasis.Methods The clinical data of176 patients with complicated hepatolithiasis who underwent operation at the Department of General Surgeryof No.960 Hospital of PLA from May 2005 to July 2015 were analyzed retrospectively.The data includedgeneral data,clinical manifestations,types of stones,operative methods,postoperative complications andfollow-up.Results There was no perioperative death.The postoperative complications which occurred in 31patients (17.6％) included lung infection,intra-abdominal infection,bile leakage,and liver failure.Eighteen patients (10.2％) were found to have residual stones.After a follow-up which ranged from 1 to 3years,152 patients (94.4％) had good clinical outcomes.Recurrent stones were found in 12 patients(7.5％).Conclusion Anatomical hepatectomy combined with intraoperative choledochoscopy improvedoperative outcomes in patients with complicated hepatolithiasis and decreased residual stone and recurrencerates.
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OBJECTIVE: To explore the safety and feasibility of ICG fluorescence fusion technique in the treatment of liver neoplasms by laparoscopic anatomical right hepatectomy.METHODS: A retrospective study was conducted to enroll 108 patients with hepatic malignancies admitted to the Department of Hepatobiliary Surgery in the People's Hospital of Hunan Province from January 2016 to December 2018.The clinical data of the patients were collected.The patient's residual liver volume was calculated before surgery,and a liver function reserve test was performed to evaluate the patient's tolerance to laparoscopic right hepatectomy.According to whether indocyanine green fusion imaging technique was performed during intraoperative laparoscopic surgery,all patients were divided into two groups:fluorescent laparoscopic anatomical right hepatic group(experimental group)and non-fluorescent laparoscopic anatomical right hepatectomy group(control group).Intraoperative and postoperative clinical data of patients in both groups were compared and analyzed.Data were reported in the form of mean ± standard deviation for numerical variables and n(%)for categorical variables.RESULTS: There were 108 patients undergoing laparoscopic anatomical right hepatectomy,including 24 patients in the experimental group and 84 patients in the control group.Three patients stained failed in the experimental group,of which 1 patient failed for forward staining method and 2 patients failed for reverse staining method.Intraoperatively,compared with the control group,the operation time of the experimental group[(274.58±42.12)min vs.(303.99±54.67)min,(P0.05)]had no significant difference between the two groups.Postoperatively,there was no significant difference in hospitalization time,tumor diameter and the incidence of lung infection,hemorrhage and bile leakage between the two groups(P>0.05).CONCLUSION: ICG fluorescence imaging laparoscopic anatomical right hepatectomy is helpful for the confirmation of intraoperative hepatic plane,thus reducing the operation time and hepatic occlusion time.It can be used for the detection of intraoperative bile leakage.The development of ICG fluorescence fusion technology is conducive to the promotion of laparoscopic anatomical right hepatectomy.Under strict conditions,it can effectively improve the controllability and safety of laparoscopic anatomical right hepatectomy.
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Digital intelligent diagnostic and treatment technology refers to a novel technology which is based by associating digitalized and intelligent high-tech with modern science to form a multi-knowledge and multi-disciplinary domain; it includes three-dimensional visualization,3 D printing,molecular fluorescence imaging,mixed reality,photoacoustic imaging,artificial intelligence-radiomis and real-time multimodal image surgical navigation.It plays a significant role in precision diagnosis,preoperative planning and intraoperative navigation of diseases.The authors' team,combining digital intelligent technology with the actual vascular distribution of patients,has been committed to the realization of individualized liver segmentation,volume calculation,simulation surgery,preoperative planning,mixed reality,tumor boundary definition and real-time image fusion for navigation in liver surgery.The research results were applied clinically,and achieved anatomical,functional,and radical hepatectomy for liver tumors.
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Objective@#To evaluate the role of anatomical hepatectomy in the treatment of intrahepatic cholangiocarcinoma.@*Methods@#The cases of intrahepatic cholangiocarcinoma who received curative surgery in two hospitals from 2010 to 2015 were analyzed retrospectively. Among the 98 patients enrolled in this study, 55 were male and 43 were female. The median age was 61 years. According to receiving anatomical hepatectomy or not, the 98 cases were divided into two groups: non-anatomical hepatectomy(n=30) and anatomical hepatectomy(n=68). The surgical results were compared between the two groups.Survival curves were plotted by the Kaplan-Meier method and compared by the log-rank test. The influence of each prognostic factor identified by univariate analysis was multivariate analysis by Cox′s proportional hazard regression.@*Results@#The duration of surgery was significantly prolonged in the anatomical hepatectomy group((196.4±94.9)minutes vs. (166.2±65.7)minutes, P=0.027), while there was no significant difference in terms of other surgical results such as intraoperative blood transfusion, postoperative morbidity and mortality rate. Compared to non-anatomical hepatectomy, anatomical hepatectomy significantly improved long-term survival results(14 months vs. 11 months)(χ2=4.641, P=0.031). Single variable analysis indicated that tumor differentiation, tumor numbers, T stage, N stage, anatomical hepatectomy and adjuvant therapy significantly affected overall survival. Multivariate analysis demonstrated that tumor numbers(HR=0.522, 95% CI: 0.259-0.974, P=0.042) and anatomical hepatectomy(HR=1.858, 95%CI: 1.092-3.161, P=0.022) were two independent prognostic factors for overall survival.@*Conclusion@#Compared to non-anatomical hepatectomy, anatomical hepatectomy performed for intrahepatic cholangiocarcinoma is not only safe but also beneficial for long-term survival.
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Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.
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Objective To study the clinical application of indocyanine green fluorescence fusion imaging (FIGFI) in anatomical hepatectomy.Methods The clinical data of 41 patients who underwent anatomical hepatectomy with guidance of FIGFI from March to June 2017 in our department were analyzed retrospectively.The data included:(l) Intraoperative data:surgical procedure,extent of hepatectomy,ICG fluorescent staining procedure and result,operation time,intraoperative blood loss and intraoperative blood transfusion.(2) Postoperative data:postoperative complications and pathology.Results Of the 35 patients who underwent laparoscopic anatomical hepatectomy,34 patients were successfully carried out under FIGFI guidance.One patient was converted to laparotomy.For the 6 patients who underwent laparotomy,liver resections were successfully carried out.Of all the 41 patients,37 had successful staining but 4 failed.Staining failure mostly occurred in patients who underwent anti-staining in liver segments with multiple vascular branching supply because not all the target liver pedicles were blocked before injecting ICG.Conclusions FIGFI guided anatomical hepatectomy is a very promising technique.The combination of preoperative imagings,intraoperative laparoscopic ultrasound guidance and FIGFI helped to achieve the goal of anatomical liver resection.
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<p>Liver metastases from colorectal carcinoma commonly form nodular lesions in the liverparenchyma. We report a case of liver metastasis from rectal adenocarcinoma that extendedpredominantly into the bile duct. A 62-year-old Japanese man underwent low anteriorresection for rectal adenocarcinoma 9 years ago. Approximately 3 years later, he underwentradiofrequency ablation therapy for a metastatic liver tumor. Nine years after surgery, atumor in liver segment III exhibiting intrabiliary extension was discovered; it wasunclear if this was a metastatic liver tumor or intrahepatic cholangiocarcinoma.Accordingly, we performed a left hepatectomy with lymph node dissection. The tumor wasnegative for cytokeratins 7 and 20, and was histologically similar to the primary rectaladenocarcinoma; it was diagnosed as rectal carcinoma metastasis. The patient has survivedfor 3 years after the hepatic surgery, for 9 years after radiofrequency ablation therapy,and for 12 years after the primary surgery. This case shows that liver metastasis fromcolorectal carcinoma can present as a predominantly intrabiliary growth that mimicsintrahepatic cholangiocarcinoma on imaging. Moreover, our case provides evidence for thesuperiority of anatomical hepatectomy over partial hepatectomy for metastatic liver tumorswith intrabiliary growth arising from rectal adenocarcinomas.</p>
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Objective To investigate the clinical effect of fissure for ligamentum teres hepatic (LTH) approach in hepatectomy.Methods The method of cross-sectional study was adopted.The clinical data of the 85 patients undergoing hepatectomy through fissure for LTH approach who were admitted to the West China Hospital of Sichuan University from February 2009 to December 2013 were collected.Among all the 85 cases, there were 61 of hepatocellular carcinoma, 12 of intrahepatic bile duct stones, 6 of bile duct cellular carcinoma and 6 of metastatic hepatic carcinoma.The operations involved dissecting fissure for LTH, dealing with portal vein, hepatic artery and bile duct inside the fissure, lowering the hepatic portal, mutilating hepatic parenchyma, and undergoing the hepatic left lateral lobectomy, left hemihepatectomy, mesohepatectomy, hepatic left and/or right trisegmentectomy.Operation method, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative drainage-tube removal time and complications were recorded.The follow-up including recurrence and metastasis of tumor and survival of patients was conducted by outpatient examination and telephone interview up to August 2015.Measurement data with normal distribution were presented as (x) ± s.Measurement data with skewed distribution were presented as M (range).The survival rate was caculated by Kaplan-Meier method.Results The 85 cases of hepatectomy were successfully completed through fissure for LTH approach, including 19 cases of hepatic left lateral lobectomy (9 with hepatocellular carcinoma, 6 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 20 cases of left hemihepatectomy (8 with hepatocellular carcinoma, 5 with intrahepatic bile duet stones, 4 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 5 cases of left hemihepatectomy + caudate lobectomy (3 with hepatocellular carcinoma, 1 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma), 14 cases of meso-hepatectomy (14 with hepatocellular carcinoma) and 27 cases of hepatic left and/or right trisegmentectomy due to hepatocellular carcinoma (15 of hepatic left trisegmentectomy and 12 of hepatic right trisegmentectomy).No perioperative death occurred.The median operation time was 280 minutes (range, 95-430 minutes).The median volume of intraoperative blood loss was 450 mL (range, 200-3 200 mL).There were 18 cases of intraoperative blood infusion.The postoperative peritoneal drainage-tube removal time was 3 days (range, 2-5 days).Eleven patients with postoperative complications recovered after symptomatic conservative treatment, including 6 with lung infection, 4 with peritoneal effusion and 1 with abdominal infection.There was no case of intra-abdominal bleeding, bile leakage or hepatic failure.No patient died within 1 month after operation.Seventy-nine patients were followed up for a median time of 38 months (range, 18-53 months) with a follow-up rate of 92.9％ (79/85).The 1-year overall survival rate and l-year disease-free survival rate were 79.0％ and 65.0％, and the 3-year overall survival rate and 3-year disease-free survival rate were 56.0％ and 34.0％, respectively.Conclusion Hepatectomy through fissure for LTH approach is safe, effective and easily operable, with a good short-term outcome.
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Objective To investigate the safety and short-term effect of anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver.Methods The clinical data of 1 patient with hepatolithiasis combined with liver atrophy-hypertrophy syndrome who was admitted to the Hunan Provincial People's Hospital in April 2014 were retrospectively analyzed.The stones were located in the left and right liver, the involved liver became fibroatrophy, and the hepatic caudate lobe not containing stones became hypertrophy.The body surface area of the patient was 1.65 m2 , standard total liver volume was 1 167.63 mL.According to the result of CT, expected residual liver volume after hepatectomy was 706.12 mL, and the ratio of residual liver volume over the standard total liver was 60.47％.The radio of residual liver volume over the body mass index was 1.21％.The patient received the second exploration of common bile ducts, hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage.The follow-up including recurrence of calculus was performed by outpatient examination and telephone interview up to April 2015.Results The patient underwent caudate lobe as the sole remnant liver following anatomical hepatectomy successfully without blood transfusion.The operation time and volume of intraoperative blood loss were 380 minutes and 350 mL.The peritoneal drainage tube was removed at postoperative day 2 and the patient was discharged at postoperative day 8 with a good recovery of liver function.The postoperative pathological examination showed that there were focal biliary epithelial papillary hyperplasia combined with light-medium atypical hyperplasia and no canceration.The T tube cholangiography two month later showed that there were unobstructed lower bile duct and no residual intra-and extra-hepatic stones.The liver function was normal.Then T tube was removed and patient resumed normal life.During the 1-year follow-up, no chills and fever, jaundice and abdominal pain occurred, no calculus was detected by B-ultrasonography, and computed tomography reexamination showed that remnant liver volume was increased and no intra-and extra-hepatic bile duct stones were detected.Conclusion Anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver is safe and feasible, with a good curative effect.
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Objective To evaluate the clinical efficacy of 1 aparoscopic anatomical hepatectomy (LaHt)in the treatment of liver cancer by comparing with Open precise hepatectomy (OHt).Methods Forty-six cases of liver tumor hepatectomy were collected by the none randomized controlled trails (non-RCTs) from January 2011 to December 2013 in Department of Hepato-Biliary-Pancreatic Surgery,Nanjing Drum Tower Hospital.According to the operation method,they were divided into two groups,including 19 cases of LaHt group and 27 cases of OHt group.Compare differences of their operation time,intraoperative blood loss,time of Pringle maneuver,and postoperative hospital stay,time of postoperative gastrointestinal function recovery,Serum liver function index,pathological tumor margin,postoperative complications,total hospitalization expenditures.Results (1) No perioperative mortality was observed in the 2 groups.(2) Compared with OHt group,LaHt group had shorter Pringle maneuver time with statistical significance (P ＜ 0.05,F =8.662) ; while,LaHt group also had less hemorrhage and shorter operation time than OHt group,although statistical significance did not existed (P ＞ 0.05,F =1.481,F =0.539).(3) Compare with OHt group,postoperative gastrointestinal function recovery of LaHt group was faster while postoperative length of hospital stay of LaHt group was shorter with obviously statistical significances existed (P ＜ 0.01,F =7.691,F =11.408).(4) The liver function index serum ALT,AST of LaHt group is lower compared to that of OHtgroup postoperative dayl and 3,however,only the day 3 AST had statistical significance (P ＜ 0.05,F =4.226).LaHt group had lower CRP level than OHt group on both day 1 and 3 after surgery,but there was no statistical significance(P ＞ 0.05,F =0.792,F =0.007).Serum TB and DB varied little between LaHt and OHt group on both day 1 and 3 after surgery without statistical significance (P ＞ 0.05,F =2.002,F =0.021,F =0.442,F =1.392).(5) The average hospital charges for the patients in LaHt group is higher than that in OH group,but there was still no statistical significance (P ＞ 0.05,F =0.046).(6) Although there was no significant difference between LaHt and OH in positive/negative excision margin ratio (P ＞0.05,x2 =1.453),there was 1 case of excision margin residues in LaHt group which would have negative effects on the prognoses.Conclusions Laparoscopic hepatectomy is a safe and feasible surgical approach,with minimally invasive advantage for treatment of liver cancer.However,compared with open precise hepatectomy,there are still some deficiencies in terms of radical curative aspect.
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Objective To explore the effects of anatomical and nonanatomical hepatectomy on the prognosis of patients with hepatocellular carcinoma(HCC).Methods A total of 62 HCC patients were enrolled,including 33 cases of anatomical hepatectomy(Group AH)and 29 cases of nonanatomical hepa-tectomy(Group IH).The operation situation and hematocrystallin(HB)loss were record.Fasting venous blood of HCC patients were extracted for detection of circulating AFP mRNA expression.The recurrence, mortality and complication rate were recorded at the same time.Results The operative time of Group AH was significantly higher than that of Group IH,while the bleeding volume and HB loss were lower(P0.05 ).There was no significant difference in complication rate between groups.Patients of Group AH got more hepatosis due to liver cirrhosis or fibrosis,while patients of Group IH got more bleeding or infection due to the central tumor.Conclusion Anatomical hepatectomy has advantages in protecting artery and improving prognosis for HCC patients,but it has surgical risks for patients with serious patholog-ical damage in hepatic lobes,and nonanatomical hepatectomy may be considered.
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Anterior approach refers to a method of hepatectomy which is first to resect the hepatic parenchyma and then to free the liver; hanging maneuver refers to placing a tape before the inferior vena cava for hanging the liver during hepatectomy.In October 2011,anatomical trisectionectomy was performed on a 54-year-old male patient with large hepatocellular carcinoma in the left medical lobe and right lobe with anterior approach and hanging maneuver.The diameter of the tumor was 16 cm,and was in the ⅢA/T3NOM0 stage.The indocyanine green retention at fifteen minutes was 5.4％,and the ratio of hepatic left lateral lobe volume over the standard total liver volume was 44％.The left bile duct was slightly dilated because of the compress of the tumor.The operation started with the isolation and dissection of the inflow vessels,including the right hepatic artery,the right portal vein,the middle hepatic artery,the portal vein branches of left internal lobe.The hepatic parenchyma transection was performed along the fight side of the falciform ligament.A tape was passed between the anterior surface of inferior vena cava and liver,and the liver was suspended during the transection.The left bile duct was cut at the right side of round ligament,and then the middle hepatic vein and the right hepatic vein were resected.The ligaments around the liver were dissected and the right hepatic lobe was removed.Finally,the end-toend anastomosis between the left hepatic duct and the common hepatic duct was performed.The operation lasted for 4 hours and the intra-operative blood loss was 350 mL.The patient was recovered well.At the end of 4 months after surgery,magnetic resonance cholangiopancreatography showed that the anastomosis of the bile duct was unobstructed,and there was no recurrence of tumor inside the liver.