Objective To state operative details of lip-shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC).Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip-shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge-shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1-,3-,5-year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface.Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.
Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions， including 5 patients with primary liver cancer， 16 patients with liver hemangioma， and 1 patient with metastatic liver cancer. The tumors locatedthe left lateral lobe in 15 cases， caudate lobe in 1 case， segmentⅣin 2 cases， and segmentⅥ in 4 cases. The meandiameter of tumors was 4cm （2-10cm）. The surgical approaches included the left lateral lobectomy （15 cases）， leftlateral lobectomy of caudate （1 case）， and nonanatomic and wedge resection were performed in 6 cases. Results Twenty-two cases underwent laparoscopic liver resection， there were no conversion to open and operative death. The mean operative time was 115min （65-142min）， the mean blood loss was 450mL （270-780mL）， the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.
Objective To study the effect of recombinant growth hormone (rhGH) on improvement of liver function and liver regeneration in animal and patients after hepatectomy. Methods The liver cirrhosis model of SD species mouse was set up, then the mouse were randomly divided into experiment group and control group, then 30%-40% liver of all the models were resected, rhGH was used by hypodermic injection (0.2-0.4ml/100g) in experimental group, and the equal dose of N.S. were given in control group every day. Then liver function, arterial blood ketone body ratio(AKBR), and the regenerated liver/body weight ratio (RL/W) were determined, histopathology of the cirrhosis with microscope and electron microscope and the mitotic index (MI) of liver cell on 7, 14 and 28th day after operation were observed. Clinically,39 hepatectomized patients were randomly divided into experiment group and control group, liver function, PA， Glu, RI and AKBR were measured preoperatively and on 1, 7,14th day after operation. Postoperative clinical course were also compared between the two groups. Results In the animal experiment group, as compared with the control group, AKBR was obviously higher (P＜0.01), seruim level of total protein and PA were increased faster (P＜0.05), and RL/W was higher. The mitotic index of liver cell was increased faster on 14th day, the numbers of regenerated liver cell with double nucleus and rough endoplasmic reticulum were higher in 14 and 28th day. In the clinical experiment group, as compared with the control group, serum total bilirubin, alanine aminotransferase and aspartate aminotransferase were lower on 7 and 14th postoperative day (P＜0.05). Serum albumin, PA, Glu, RI and AKBR were higher on 7, 14th postoperative day (P＜0.05). Conclusion Both experimental and clinical study show that the rhGH can promote liver regeneration and improve liver function after hepatectomy.
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.
Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
Objective To discussion the surgical approach of laparoscopic resection of left hepatic lobe. Methods The clinical data of 86 patients with Intr- and extra-hepatic bile duct stones and liver hemangioma were analyzed retros-pectivly. Eighty-six patients underwent laparoscopic hepatectomy. Forty-nine cases underwent the left hepatic lobe resectionby the left longitudinal groove （left longitudinal groove group）， 37 cases underwent the left hepatic lobe resection by the first hepatic portal （first porta hepatis group）. The operative time， intraoperative bleeding volume， postoperative hospital stay， and postoperative complications of two kinds of operation were compared. Results The operative time and intraoperative bleeding volume of left longitudinal groove group were shorter or less than those of the first porta hepatis group 〔（142±123）min vs. （208±58）min，P＜0.05； （320.5±38.3）mL vs. （450.9±39.1）mL，P＜0.05〕. There were no statistically significant difference between the 2 groups in complication and hospitalization after operation （P＞0.05）. Conclusion The left hepatic lobe resection by the left longitudinal groove is more safe and fast.
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
【Abstract】Objective To investigate the influence of hepatectomy combined with splenectomy on curative effect of primary hepatocellular carcinoma patients associated with hypersplenism.Methods Twenty three cases of primary hepatocellular carcinoma associated with hypersplenism were analyzed retrospectively and divided into hepatectomy combined with splenectomy group (n=10) and hepatectomy combined with ligation of splenic artery (n=13). Peripheral blood samples were collected 1 week before operation and 3 monthes after operation respectively. The levels of CD4, CD8, CD16, CD4/CD8, WBC and PLT in the blood were detected. Survival rate between the two groups was compared. Results There were not significant differences in the expressional levels of CD4, CD8, CD16, CD4/CD8,WBC and PLT before operation, bleeding quantity during the operation and rate of severe complications after operation in the two groups. The expressional levels of CD4, CD16, CD4/CD8, WBC and PLT of hepatectomy combined with splenectomy group were much higher in 3 months after operation than those in 1 week before operation and in hepatectomy combined with ligation of splenic artery group (P＜0.01) and the latter with no distinct changes of the above indexes. There was no difference of survival rate between the two groups. But in the hepatectomy combined with ligation of splenic artery group, 7 patients of 13 patients were compelled to terminate chemotherapy because of their low WBC while not a single patient was forced to do so in the hepatectomy combined with splenectomy group. Conclusion Hepatectomy combined with splenectomy is useful for patients with hepatocellular carcinoma associated with hypersplenism to restore the immunological function and the application of chemotherapy after operation.
ObjectiveTo discuss the feasibility, safety, and superiority of da Vinci surgery system (DVSS) in liver tumor resection. MethodThe clinical data of 21 patients who underwent DVSS in the liver tumor resection were analyzed retrospectively. ResultsThere were 12 patients with hepatocellular carcinoma (HCC), 1 patient with cholang-iocellular carcinoma, 1 patient with hepatic cirrhosis regenerative nodule, 2 patients with metastatic adenocarcinoma, 2 patients with leiomyosarcoma, and 3 patients with cavernous hemangioma.The operative time was (156.67±92.19) min (60-480 min), the intraoperative blood loss was (585.71±1 076.12) mL (50-5 000 mL), the time of diet recovery was (3.23±1.26) d (2-6 d), and the hospital stay was (10.10±9.02) d (5-47 d).The hospital mortality and morbidity rates were 0(0/21) and 9.52%(2/21) respectively including 1 patient with biliary leakage and 1 patient with abdominal infection. ConclusionThis study demonstrates the feasibility and safety of DVSS in the liver tumor resection and the system has a wide range of application for patients who are suffering from liver tumor.
ObjectiveTo summarize the definitions, risk factors, and preoperative evaluation methods of posthe-patectomy liver failure. MethodsDomestic and international publications involving posthepatectomy liver failure were retrieved and reviewed. ResultsThere was no uniform definition of posthepatectomy liver failure, however, the most approbatory definitions were "50-50 criteria" and "International Study Group of Liver Surgery (ISGLS) criteria". Risk factors of posthepatectomy liver failure included patient-related factors, liver-related factors, and surgery-related factors, and preoperative evaluation was mainly based on liver function and liver volume. ConclusionPosthepatectomy liver failure is the main cause of postoperative death, sufficient preoperative evaluation and effective measures to decrease intraoperative blood loss and shorten surgery duration are helpful to prevent and (or) reduce posthepatectomy liver failure.