Analysis Of Precise Hepatectomy For Early Hepatocelluar Carcinoma

OBJECTIVETo evaluate the value of precise hepatectomy for early-stage primary liver cancer after radical resection.MethodThe clinical data of 175 patients who underwent curative hepatectomy for early-stage HCC at THE Nan Fang Hospital form July 2012 to June 2014 was analyzad,BCLC-A period as the inclusion criteria for the early-stage HCC,divided all cases into two groups:the precise group and the traditional group,of which 118 cases were precision group,56 cases were traditional group.Precise group:not to occlude the blood flow of porta hepatis or selectively occlude the affected side of the hepatic blood inflow(some patients occlude the affected side of the outflow tract hepatic blood together),the liver tissue were separated by the modern energy surgical instruments,ligated the duct respectively that encountered form the process of hepatectomy,until the target liver tissue complete resection,the liver section planes were left without suture.Traditional group:Pringle maneuver was performed to occlude the blood flow of porta hepatis,the liver tissues were separated by vascular clamping,the vascular occlusion was "15 +5" mode,intermittently occlude the blood flow until the targets were completely removed,the liver section planes were sutured after surgery.The observation target:(1)Basic data:gender,age,basic liver disease,preoperative albumin,AFP,ALT,AST,Tbil level,drinking history,smoking history,height,BMI index,hepatitis B virus quantification;(2)surgical data:operation time,number of blood transfusion,volume of intraoperative blood loss;(3)Postoperative recovery:the variation trend of the ALT,AST,Alb,Tbil at the postoperative 1,3,5,7d,,postoperative length of hospital stay,drainage tube retention time,postoperative complications,postoperative expenditure,(4)Pathological data:diameter of maximal tumor,histological type,liver cirrhosis;(5)follow-up:postoperative AFP,imaging findings,1 or 2 years after the recurrence time.ResultsThere was no significant difference between the two groups in the general data(P>0.05).There was no significant difference between the accuracy group and the traditional group(P>0.05).The operation time of the precise group was slightly longer than that of the traditional group,and the difference was statistically different.The incidence of postoperative complications was higher in the traditional group than in the precise group.There were 13 cases of complication in the traditional group(6 cases of pulmonary infection,3 cases of abdominal infection,2 cases of incision infection and 2 cases of pleural effusion)The incidence of complications was 23.2%.There were 8 cases of complication in the precise group(4 cases of pleural effusion,2 cases of pulmonary infection,1 case of abdominal infection and 1 case of incision infection).The complication rate was 6.8%Group was statistically different(P<0.05).The median hospital stay was 10.5 days in the traditional group and 9 days in the precise group.The difference was statistically significant(P<0.05).The median time of catheter drainage was 7 days in the traditional group and 6 days in the precise group.There was a significant difference between the two groups(P<0.05).The levels of AST and AST in the serum of the two groups were significantly lower than those of the traditional group(P<0.05).The accuracy of the postoperative group was significantly higher than that of the control group 1 day albumin level was slightly lower than that of the traditional group,but there was no statistical significance(P>0.05).The albumin level was faster than the traditional group at the 3rd,5th and 7th day after operation,the difference was statistically significant(P<0.05).The levels of serum total bilirubin in the total bilirubin level were significantly lower than those in the conventional group at 1,3 and 5 days after operation(P<0.05).Follow-up:79.7%(94/118),60.9%(46/118),50%(28/56),46.4%(26/56)in the conventional group,There was significant difference between the two groups(χ2=4.741,8.722,P<0.05).ConclusionFor the early-stage HCC patients to perform precise hepatectomy,the recovery of liver function faster,and minimize the incidence of complications,the length of hospital stay and drainage tube retention time is shorter,with better near-term efficacy,which is worth recommending.