Application Of Laparoscopic Ultrasound In Laparoscopic Hepatectomy Of Difficult Right Liver

Objective : To explore the application of Laparoscopic ultrasound(LUS)in laparoscopic hepatectomy of difficult right liver.Methods: The clinical data of 59 patients who underwent laparoscopic resection of liver tumor in difficult part of right liver from January 2017 to January 2021 in our hospital were retrospectively analyzed.Liver ultrasound,abdominal CT or MRI were performed before operation,and confirmed that the patients were occupied by the right liver difficult position(VI / VII junction,VII segment,VII / VIII junction,VIII segment and V / VIII segment junction).The liver reserve capacity was evaluated by child Pugh liver function grading standard and indocyanine green excretion test(ICG).Preoperative liver function of all patients reached grade A,and all patients underwent laparoscopic hepatectomy.Postoperative pathology confirmed that all patients were malignant tumors.Analyze the gender,age,underlying disease,tumor size,tumor location,preoperative liver function reserve,operation time,intraoperative blood loss,intraoperative blood transfusion,number of blood transfusion cases,number of hepatic portal blockades,resection margins,Postoperative complications(liver failure,bile leakage,pleural effusion,pneumonia,pulmonary insufficiency),postoperative liver function,postoperative catheterization time,postoperative hospital stay and other indicators.Results: All patients underwent laparoscopic surgery.In the observation group,10 cases of tumors were located at the junction of V / VIII,19 cases at the junction of VI /VII,3 cases at the junction of VII and 5 cases at the junction of VIII.In the observation group,34 cases underwent local hepatectomy and 3 cases underwent anatomical resection of right posterior lobe of liver.In the control group,6 cases were located at the junction of V / VIII,11 cases at the junction of VI / VII,4 cases at the junction of VII and 1 case at the junction of VIII.In the control group,21 cases underwent local hepatectomy Anatomical resection of the right posterior lobe of the liver was performed in 1 case.In terms of gender,age,underlying disease,tumor size,tumor location,preoperative liver function reserve and other related data,the two groups were not significantly different(P>0.05),and they were comparable.The observation group was less than the control group in terms of intraoperative blood loss,intraoperative blood transfusion,number of blood transfusions,postoperative tube time,postoperative hospital stay,postoperative liver function indexes(ALT,AST),and the incidence postoperative acute liver failure(P<0.05),there was significant difference.Patients in both groups recovered well and were discharged.Conclusion: Application of LUS in laparoscopic surgery for tumors in difficult parts of the right liver: 1.It can reduce the amount of intraoperative blood loss,intraoperative blood transfusion,the number of blood transfusion cases and the number of hepatic portal blockades.2.It can retain more residual liver volume,speed up the recovery of liver function after surgery,and reduce the occurrence of PHLF.3.It can reduce the time of postoperative catheterization and shorten the postoperative hospital stay.