Under the guidance of the concept of precise anatomical laparoscopic liver resection for hepatocellular carcinoma / 国际外科学杂志

ABSTRACT

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.