Clinical Research On The Surgical Safety Of Patients With Primary Hepatocellular Carcinoma

Part I The risk factors of post-hepatectomy liver dysfunction for primary hepatocellular carcinomaObjective The purpose of this study was to analyze the perioperative risk factors for post-hepatectomy liver dysfunction after liver resection because of primary hepatocellular carcinoma (PHC).Method Clinical databases of298PHC patients from January2011to April2013was analyzed retrospectively, and Single variant and multivariate stepwise regression models were used to analyze the potential pre-and intraoperative risk factors associated with postoperative hepatic dysfunction after resection of PHC simultaneously.Result We found there are twelve risk factors effecting the extent of post-hepatectomy liver dysfunction, and they are Aspartate Transaminase(AST), Albumin(ALB), Alkaline Phosphatase(ALP), Total Bilirubin(TBIL),Gamma Glutamyl Transferase(GGT), the indocyanine green retention rate at15minute(ICG-R15), the size of tumor, Chronic Liver Dysfunction Scores (CLD), the time of whole operation and the hepatic inflow occlusion, the removal segments and the intraoperative bleeding. Logistical multivariate analysis showed that the independent risk factors of preoperative and intraoperative were indocyanine green retention rate at15minute (ICG-R15), the time of hepatic inflow occlusion as well as the whole operation and the removal segments, respectively.Conclusion The degree of the posthepatectomy liver dysfunction relied mainly upon ICG-R15, the time of hepatic inflow occlusion as well as the whole operation and the removal segments. Part II Effects of different hepatic inflow occlusion methods in hepatectomy for primary hepatocellular carcinomaObjective Evaluate the respective effect of three hepatic inflow occlusion methods in hepatectomy for primary hepatocellular carcinoma.Method The clinical data of218patients undergoing hepatectomy for large hepatocellular carcinoma were analyzed, respectively. According to the method of hepatic inflow occlusion, patients were divided into Group Pringle (88cases undergoing pringle maneuver), Group selective semi-hepatic vascular occlusion (51cases undergoing selective semi-hepatic vascular occlusion), Group combination (79cases undergoing infrahepatic inferior vena cava(IVC) clamping combined with Pringle maneuver). The operative time, cross-clamping time, intraoperative bleeding volume, the removal segments, the ratio of blood transfusion, postoperative liver function among the3groups were compared.Result There were no significant difference in preoperative conditions, operation time, cross-clamping time and the removal segments (P>0.05). Group combination was significantly less than Group Pringle and Group selective semi-hepatic vascular occlusion in the intraoperative bleeding volume and the ratio of blood transfusion (382.29+166.18mL,25.31%;728.98±500.21mL,35.23%;432.84±127.13mL,29.41%;P<0.05). Group selective semi-hepatic vascular occlusion and Group combination were more improved than that Group pringle in the AST (Aspartate Transaminase, AST)、 ALT (Alanine Transaminase, ALT) and TBil (Total bilirubin, TBil) on the third and seventh day after hepatectomy, and the difference was statistically significant (P< 0.05).However, there was no statistically significant in the index albumin and the incidence of postoperative complications among three groups.Conclusion The method of infrahepatic inferior vena cava(IVC) clamping combined with Pringle maneuver is a safe and effective technique in hepatectomy, which can reduce intraoperative blood loss and blood transfusion rate significantly and promote the patient recovery without increasing the incidence of postoperative complications.