Application Of The Method Of Selective Hemihepatic Vascular Exclusion In Hepatectomy Of The Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the fifth most common cancer in theworld, and is the third highest cause of cancer-related mortality.Annual newcases of HCC has about 350,000 people, about 320,000 people died of thedisease , the morbidity and mortality rates are as high as second only to stomachcancer and esophagus cancer in common in China. Overall, 80% of cases ofHCC are attributable to chronic viral infections with either hepatitis B orhepatitis C virus. Hepatitis B infection is the main risk factor in Asia and Africa.In Western countries and Japan, hepatitis C infection is the main risk factor.Other causes of HCC include alcoholic liver cirrhosis and aflatoxin B. Earlydiagnosis and treatment, is still essential.HCC's prognosis has been greatlyimproved due to the major advances in its clinical treatment and basic researchsince 1950's. Currently the tumor marker(AFP)and imaging studies are most convenient. Each treatment modality for HCC can be considered to have one ofthree goals: cure, local control and bridge to transplantation, and palliation,currently combined therapy is major method in HCC's treatment.Surgical resection is still the primary means of achieving long-term survivalof HCC patients. Hemorrhage has always been the principal concern duringhepatic resection for HCC. Massive bleeding and liver failure are the major riskfactors in hepatic resection. With the birth of Pringle maneuver in 1908,thedevelopment of various effective vascular control measures has greatly reducedthe intraoperative hemorrhage during hepatic resection. Each method has theadvantage and disadvantage of itself. The goal of rational choice of hepaticvasclular occlusion is the least hemorrhage, the least liver lesion,the leastinfluence of associate organ and convenient manipulation.Our hospital hasanalyzed the effect of hemihepatic vaslular clamping in hepatic resection in therecent year and we has gained satisfacted result.But hemihepatic vaslularclamping is more complicate, the operative time is more longer.To investigate more rational and convenient method,this article observed theapplication of selective hemihepatic vascular exclusion in hepatectomy of thehepatocellular carcinoma.We hope that this article may provide a easy andpractical method for hepatic vaslular occlusion in hepatectomy．ApplicatioApplication of the method of selective hemihepatic vascularexclusion in hepatectomy of the hepatocellular carcinomaAIM:To investigate the effect of the method of selective hemihepatic vascularexclusion in hepatectomy of the hepatocellular carcinoma．METHODS:92patients underwent hepetectomy with 3 differernt hepatic vascular occlusion,45 patients received hepatectomy with Pringle manoeuvre(group A),30 patientsreceived hepatectomy with hemihepatic vascular clamping (group B),17 patientsreceived hepatectomy with selective hemihepatic vascular exclusion(groupC).Relative surgical parameters,the change of postoperative liver function,recovery of intestine function and postoperative complications are evaluated.RESULTRESULTS:There was no operative mortality. There was no significantdifference in intraoperative blood loss, occlusion time, recovery of intestinefunction,abdominal infections after operation,bile leakage, alimentary tracthemorrhage and refractory ascites among three groups．The operative time ofgroup B was longer than those of group A and group C (P＜0.05),but therewas no significant difference between group A and group C statistically. Thepostoperative liver function of group A was worse than those of group B andgroup C (P＜0.05),however, there was no significant difference between groupB and group C statistically. CONCLUSION:The method of selectivehemihepatic vascular exclusion is better than two other methods,which is aneasy and practical method for hepatectomy．...