Clinical Analysis Of 33 Cases Of Laparoscopic Liver Cancer Resection And Preliminary Study On Surgical Countermeasures

ObjectivesBy comparing the clinical efficacy of laparoscopic hepatectomy(LH)and open hepatectomy(OH)in the treatment of hepatocellular carcinoma to further confirm the safety and feasibility of LH.By analyzing the advantages and disadvantages of LH,exploring the difficult points and countermeasures of LH and discussing the indications and contraindications of LH,to provide some guidance for the clinical treatment of hepatocellular carcinoma.MethodsA retrospective analysis of 102 patients with hepatocellular carcinoma(HCC)who underwent hepatectomy from September 2016 to September 2018 in the Department of Hepatobiliary Surgery on Shandong Provincial Hospital.Among them,41 patients underwent laparoscopic hepatectomy and 61 patients underwent open hepatectomy.However,due to the significant difference in tumor location(P=0.013)and tumor size(P=0.005),Considering the size and position of the tumor to some extent affect the surgical approach.In order to match the data as much as possible,according to the similarity of tumor location and size,patients without excessive tumor location,unclear relationship with hilar structure or inferior vena,portal vein tumor thrombus or cholangiocarcinoma or secondary surgery were selected,and 33 patients in the laparoscopic surgery were selected as the LH group,and 33 of the patients underwent laparotomy were OH group.After deletion,Tumors in each group were located in the left hepatic liver in 13 cases,right hemi-hepatic in 19 cases,and caudate lobe in 1 case.Tumor diameter(4.3 ± 2.1 cm in the LH group vs 4.4 ± 2.2 cm in the OH group,P = 0.876)was almost equal.Preoperative data(age,gender,tumor size and location,preoperative AST,ALT,TBIL,ALB,AFP),intraoperative data(operative time,intraoperative blood loss),postoperative Data(days hospitalization,postoperative complications,drainage tube placement time,postoperative fasting time,AST,ALT,TBIL,ALB on the second postoperative day)were collected to be compared.The patients were followed up for a follow-up period from 6 mouths to 30 months.The tumor-free survival rate of each group was compared.ResultsThere was no significant difference in preoperative data between the patients(P>0.05).The mean intraoperative blood loss in the LH group was obviously lower than that in the OH group(191.2±114.3 m L vs 315.1±256.1 m L,P=0.015),and there was a statistical difference(P<0.05);The mean operative time(160.4±69.6 min)in the LH group was slightly more than that in the OH group(148.7±53.9 min),but there was no statistical difference(P=0.448>0.05);The average hospital stay(10.6±3.2 d vs 16.2±6.2 d,P=0.000),drainage tube placement time(4.4±2.0 d vs 7.7±3.8 d,P=0.000),and AST on the second postoperative day(121.5±74.9 U/L vs 213.3±225.8 U/L,P=0.033),ALT(156.0±102.1 U/L vs 156.0±102.1 U/L,P=0.015),TBIL(20.2±6.9 mol/L vs 31.0±24.1 mol/L,P=0.018)in the LH group were lower than in the OH group,and differences are statistically significant(P<0.05);The average fasting time(2.4±1.2 d vs 2.6±0.9 d,P=0.412)and the second day postoperative ALB(33.2±4.4 g/L vs31.7±4.3 g/L,P=0.342)in the LH group are slightly better than in the OH group,but there are no statistical difference(P>0.05).There were 3 cases(9.1%)with complications in the LH group and 6 cases(18.2%)in the OH group.There was no significant difference in the incidence of complications between the two groups(P=0.473>0.05).The tumor-free survival rates in the LH group were 78.8% and 66.7% in the 3rd and 6th months and the tumor-free survival rates in the OH group were 66.7% and 54.5% in the 3rd and 6th months.On the survival time,df=1,χ2=1.555,P=0.212,and there is no statistical difference.Conclusions1.For appropriate cases,laparoscopic hepatectomy(LH)has the advantages of less surgical margin,less intraoperative blood loss,faster postoperative recovery,shorter hospital stay,and less surgery time than open hepatectomy(OH).And it does not increase surgery time and the risk of postoperative complications.2.The short-term efficacy of LH is clear,but the long-term efficacy requires multi-center prospective randomized controlled trials to further confirm.3.LH is safe and effective in the treatment of HCC,but indications and contraindications should be strictly controlled.4.Because laparoscopic hepatectomy is an emerging technology,a large number of multi-center studies are needed to improve the indications and contraindications of LH and related clinical practice applications.