Liver Precise Resection For The Treatment Of Primary Liver Cancer And Reducing Its Recurrence Rate

Ⅰ.purpose Primary hepatocellular carcinoma(PHC)is a common malignant tumor,which is mainly treated by surgery.Hepatectomy is the most effective treatment for PHC.In this paper,the application of precise hepatectomy in primary hepatocellular carcinoma was studied,in order to provide a basis for better treatment of patients with primary hepatocellular carcinoma.Ⅱ.Method 120 patients with primary hepatocellular carcinoma admitted to the Department of hepatobiliary surgery in our hospital from April 2015 to April 2017 were enrolled in this study.There were 63 male patients and 57 female patients,aged between 34 and 69,with an average age of 58.7±2.9 years.Among the 120 patients,56 had abdominal pain,18 had no complaints of discomfort,and the rest had other symptoms such as fatigue,emaciation and jaundice.The preoperative Child-Pugh score for liver function in the study group was A or B,and the preoperative staging was BCLC-A according to the Barcelona Clinical Liver Cancer Staging System(BCLC).On the basis of the consent of patients,according to the different surgical resection methods,the above-mentioned subjects were divided into observation group and control group,60 patients with precision hepatectomy as observation group,60 patients with routine hepatectomy as control group.Observation group:1.Do not block the hepatic blood flow or selectively block the hepatic blood flow into the resection section during the operation,use surgical energy instruments to fine hepatectomy,firmly ligate the hepatic duct encountered in the process of hepatectomy,do not suture the liver section;2.Reduce the central venous pressure(<5 cmH2O)during the operation to control intraoperative hemorrhage;3.Use the regular hepatectomy methods guided by MHV;4.The location of methylene blue in the Glisson sheath of pre resected liver segments was studied.Control group:1.The hepatic blood flow was cut off by Pringle occlusion method,and the hepatectomy section was sutured in the opposite direction.2.The normal central venous pressure(NCVP group)was used during the operation.3.The middle hepatic vein(MHV)was not used as the guide in hepatectomy.4.Do not carry out Glisson intrathecal staining and localization of target liver segment.Observed indicators:(1)Preoperative basic data:gender,age,AFP,ALT,AST,Tbil levels,hepatitis history,cirrhosis cases;(2)Surgical related indicators:operative time,intraoperative bleeding volume,postoperative hospital stay,postoperative drainage,hospitalization costs;(3)The liver function and prothrombin time were compared between the two groups one week after operation;(4)postoperative complieations comparison between the two groups;(5)postoperative follow-up:Comparison of recurrence rate and survival rate in one year after operation.Ⅲ.Results1、Comparison of basic data of two groups before operationThe results showed that there was no significant difference between the two groups in preoperative basic data(gender、age、AFP、ALT、AST、Tbil level、history of hepatitis、cirrhosis cases)and no statistical significance(P>0.05).2、Comparison of the results of operation related indicators between the two groupsThe results showed that the operation time,intraoperative bleeding volume,postoperative drainage,postoperative hospitalization time and hospitalization expenses of the patients with precision hepatectomy were lower than those of the patients with traditional hepatectomy.The difference between the two groups had statistically significance(t=4.34,P<0.05).3、Comparison of liver function and prothrombin time in two groups one week after operationALT,AST and Tbil in the precision hepatectomy group were lower than those in the traditional operation group.There were significant differences between the two groups(P<0.05).PT of the precision hepatectomy group was 13.3±2.1 s and that of the traditional operation group was 15.2±2.2 s(t=3.12,P>0.05),indicating that there was no significant difference between the two groups.4%Comparison of postoperative complications between the two groupsThe incidence of complications in the observation group(6.67%)was significantly lower than that in the control group(18.33%).There was a significant difference between the two groups(χ2=6.89,P=0.04)。5、Comparison of postoperative follow-up between the two groupsThe two groups were followed up for one year.The one-year receurrence rate(30.2%)in the precision hepatectomy group was lower than that in the traditional hepatectomy group(34.8%).The difference between the two groups was statistically significance(χ2=16.29,P=0.04);the one-year survival rate(87.4%)in the precision hepatectomy group was higher than that in the traditional hepatectomy group(73.1%).The difference between the two groups was statistically significance(χ2=6.65,P=0.04).Ⅳ.ConclusionAccurate hepatectomy is superior to traditional hepatectomy in terms of intraoperative bleeding volume,postoperative complications,postoperative liver fimction recovery,postoperative hospital stay,one-year recurrence rate and survival rate.Accurate hepatectomy is a recommended method for hepatectomy,which can clearly display the various hepatic duct systems and treat them accurately and reliably,thus preserving the blood supply and reflux of residual liver as much as possible and maximizing the protection of residual liver function.