Clinical Study Of 84 Cases Of Laparoscopic Hepatectomies And Open Hepatectomies

Objective:To evaluate the safety and feasibility of laparoscopic hepatectomy(LH) in early stage by comparing and studying the surgical features and postoperative courses between LH and open hepatectomy(OH),and acts as an reference to the following process of LH.Methods:This research collect 84 cases of hepatectomies performed in our hospital from 2012.01 to 2015.03,including 42 cases of LHs (LH group) as well as 42 cases of OHs (OH group).20 cases (47.6%) in the LH group suffer benign disease and 22 cases (52.4%) suffer malignancy;the ratio of male to female is 11 to 10.17 cases (40.5%) in the OH group suffer benign disease and 25 cases (59.5%) suffer malignancy;the ratio of male to female is 12 to 9.Ensure the two groups to be at the same level in age,location and volume of the lesion, the Child-Pugh level and qualification of the surgeon performing the surgery.None of them suffers organic disease in heart,lung or brain.Compare and study retrospectively surgical features and postoperative course between group LH and OH,and analyse the relationship between surgical features (operation time and blood loss) and surgery quantity,as well as surgical method.Results: All procedures were completed successfully and 84 patients discharged safely.Compared with group OH,group LH is longer in operation time(225.6±83.3 vs 140.4±54.8), and smaller in porta hepatis blocking (10.5%(4) vs 50%(21)).In group LH,postoperative ALT peak level (145.7±138.4 vs 243.0±199.8) is lower, postoperative ALB level (35.3±3.7 vs 32.7±4.7) higher,and postoperative fasting time (2.4±1.9 vs 3.5±1.8) as well as hospital stay (7.2±3.2 vs 10.0±3.5) shorter.All above are statistically significant (P<0.05).The differences between group LH and OH in blood loss and biood transfusion during operation postoperative blood transfusion, postoperative abdominal effusion volume and complication morbidity are not statistically significant (P>0.05). Operation time of laparoscopic left hemihepatectomy (266.7±78.7) is longer than laparoscopic liver wedge resection (205.7±56.2, P<0.05) and left lateral lobectomy (200.6±56.9, P=0.06),and operation time of LH decreases with the increasing of surgery quantity.Biood loss of LH during operation is not relevant with surgical method, but decreases with the increasing of surgery quantity.Conclusions:Surgical experience is an important factor affecting the surgical features of LH as operation time and blood loss in LH decreases with the gaining of surgical experience. In some selected patients,laparoscopic hepatectomy(LH) is safe and feasible and has some advantages over open hepatectomy(OH), while operative time of LH in early stage is obviously longer than OH.