Laparoscopic Versus Open Hepatic Resections: An Experimental Comparative Study

Objective:Laparoscopic hepatic resection is still on the stage of research due to its high difficulty and complexity on operation. In order to study the laws and mechanisms of the physiological environment after laparoscopic hepatic resection and offer help for clinical application, we compared the results of porcine immune function after LH with those after OH.Methods:30 experimental swine which were undergone left lateral hepatectomy were divided into two groups, LH group and OH group. The experiment was undergone approach to human being's physiological and anatomical condition. In group of LH, after CO2 pneumoperitoneum was established, the ligaments around liver were dissociated. Livers were cut off by the clamp dissection. The operative means of the group of OH was just like the traditional human open hepatectomy. The operation time,bleeding volume,mortality and peri-operative immune indices and stress index were compared between two groups, such as the IgA,IgG,IgM,CD3+,CD4+,CD8+,C3,C4,NK cells,WBC and GRA count,AD and Cor.Results:All the hepatic resection operations were successful except one in OH due to the incomplete anesthesia monitoring. In OH the minimal operating time was 60min, maximum was 120min, mean was 80.21min. In LH the minimal operating time was 50min, maximum was 120min, mean was 76.88min. In OH the minimal bleeding volume was 100ml. maximum was 300ml, mean was 220.16ml. In LH the minimal bleeding volume was 100ml, maximum was 500ml, mean was 306.25ml. The operating time of two groups had no difference(P>0.05). Although the bleeding volume of LH is more than that of OH, it had no significant difference(P>0.05).The value of IgA. IgG and IgM fell rapidly after the operation in both two groups. Compared with the group of OH, the decline of the LH group was less. The density of the immunoglobulin raised in the first day after the operation, while dropping to the lowest value in the second day in group of OH. The value of IgG in the first day after the operation and that of IgM,IgA in the second and third day after the operation between two groups had significant difference(P<0.05).The value of C3 and C4 fell rapidly after the operation in both two groups. Compared with the group of OH, the decline of the group of LH was less. The value of C3 in the three days after the operation and that of C4 between two groups had significant difference(P<0.05), the same to the C4 just after the operation.Compared with preoperation, The value of CD3+,CD4+ and CD8+ fell significantly after the operation in both two groups(P<0.05). The value of CD3+,CD4+ and CD8+ in the second and third day after the operation between two groups had significant difference(P<0.05).NK cells had no significant difference both in the group and between two groups. (P>0.05)Compared with preoperation, The value of WBC,GRA,AD,Cor rose significantly after the operation in both two groups(P<0.05). The value of WBC,GRA,AD,Cor in the second and third day after the operation between two groups had significant difference(P<0.05).Conclusions:1. Laparoscopic hepatic resection is a very complicated and difficult operation.2. Bleeding control is the key technique in the surgery procedure. 3. There are advantages of laparoscopic hepatic resection such as mini-invasion and fast postoperative recovery.4. It must be conversed to open operation when uncontrolled bleeding occurs.5. The surgery of LH can suppress the body's immune function. Compared with the surgery of OH, LH is less-invasive. The reason is LH has small incision, less pain and disturbance to the bowels.