The Application Of BiClamp(?) In Liver Resection For Liver Cirrhosis Liver Caner Without Hepatic Blood Inflow Occlusion

Background and aimHepatectomy is the primary therapeutic approach for liver diseases.The development of liver resection technologies greatly improves the success rate of liver surgery.This technology has been improved since the creation of The application of BiClamp(?)in liver resection in 2007.Previous randomized controlled trials and clinical retrospective studies showed that BiClamp(?)forceps for liver recection can significantly reduce intraoperative blood loss,reduce the number of blocked hepatic blood flow and hepatic blood flow blocking time.The reperfusion trauma caused by the blockage of blood flow to the liver affect the recovery of liver function after surgery,especially in patients with liver cirrhosis.To evaluate the efficacy and safety of BiClamp(?)in liver resection for liver cirrhosis liver caner without hepatic blood inflow occlusion.MethodFrom June 2014 to September 2017,72 patients with liver cirrhosis and malignant1iver tumor undergoing liver resection were randomized to without hepatic blood flow occlusion group(n=36)and hepatic blood flow occlusion group(n=36).All patients operated by the same surgical group.All hepatectomies were performed using BiClamp(?).The operative time,liver cut surface area,liver transaction time,transaction speed,intraoperative blood loss,blood loss per transection area,the rate of blood transfusion,the rate of postoperative complications,the postoperative hospital stay,and levels of ALB,AST,ALT and TB on the postoperative day(POD)1,3and 7 in two groups were compared.Results1.There were 42 males and 30 females were included in the study whose mean age was56.6±11.0 years old(29~77 years old).64 patients were in Child-Pugh grade A group and 8 patients were in Child-Pugh grade B group.The largest tumor diameter of 2.5~15cm,single tumor in the left outer lobe in 14 cases,11 cases of left lobe,right anterior lobe in 20 cases,16 cases of right lobe of the liver,the other more than 2 lesions in 11patients.2.There were no significant differences between the without hepatic blood flow occlusion group and hepatic blood flow occlusion group in the operative time(182.5±66.81min vs 188.47±66.97min;p=0.707),liver cross-sectional area(63.79±36.48cm~2 vs65.55±46.30cm~2;p=0.315),liver transection time(32.70±25.40min vs 27.58±18.16min;p=0.215),liver transection speed(2.21±0.72cm~2/min vs 2.46±0.86cm~2/min;p=0.286),intraoperative blood loss(369.26±295.97ml vs 346.00±248.63ml;p=0.613),and operative morbidity(22.2%vs 33.3%;p=0.293).3.There were no significant differences in the levels of ALB on the POD1(34.88±4.85g/L vs 34.82±3.56g/L;p=0.184),3(38.98±4.00g/L vs 34.12±3.65g/L;p=0.382)and 7(38.59±4.36g/L vs 36.18±2.81g/L;p=0.06).There were no significant differences in the levels of ALT(242.08±216.77u/L vs 344.17±311.72u/L;p=0.368),AST(235.33±169.32u/L vs 247.42±178.23u/L;p=0.845)on the POD 1.4.Thewithouthepaticbloodflowocclusiongroupshowed1evelsof ALT(142.36±84.29 u/L vs 252.50±207.07u/L;p=0.027)and AST(94.78±65.10u/L vs139.22±107.69u/L;p=0.002)on the POD 3 and 1evels of ALT(74.58±51.06 u/L vs100.31±77.71u/L;p=0.034)and AST(38.42±17.32u/L vs 55.28±36.28u/L;p=0.001)on the POD 7 lower than in the hepatic blood flow occlusion group.The without hepatic bloodflowocclusiongroupshowed1evelsofTB(17.72±6.65umol/L vs21.67±9.42umol/L;p=0.022)on the POD 1 and 1evels of TB(14.7±7.28umol/L vs 16.70±9.90umol/L;p=0.024)on the POD 7 lower than in the hepatic blood flow occlusion group.ConclusionFor the patients with liver cirrhosis undergoing liver resection without hepatic blood inflow occlusion,BiClamp(?)would reduce the injury to the liver function,not increase the intraoperative blood loss and contribute to the early recovery of postoperative liver function.