Clinical Application Of Laparoscopic Precise Hepatectomy

Objective:Explore the feasibility, safety, advantages of laparoscopic precise hepatectomy and clinical application value.Metheds:Following case Inclusion Criteria, collect cases in our center during March2010to December2011, according to the principle of random group, divide into the control group and the experimental group,25cases in the control group(LPH),26cases in the experimental group(OPH). Preoperative using Child classification and Indocyanine Green discharge test evaluated liver function reserves accurately. All of the subjects had given liver CT three-dimensional visualization, Learn more about the lesion, intrahepatic vein distribution and the relationship between the two; determine the scope of surgical resection Intraoperative find liver resection plane or liver using regional blocked blood flow, given laparoscopic precise hepatectomy and open precise hepatectomy respectively. Follow the principle of no-touch in the malignant tumors Monitoring indicators:operation time; intraoperative blood loss; intraperative blood transfusion; tumor resection margin; liver resection volume; length of incision; analgesics;the Oral intake time and first time off the bed after surgery; drainage volume of the abdominal cavity drainage tube;The time withdrawing tube; complications; total hospital cost;hospital stay; preoperative, The first day, second day, third day, fifth day, seventh day of white blood count, C-reactive protein, Aspartate aminotransferase,Alanine aminotransferase respectively after surgery.Results:Two groups of patients are successfully performed, no deaths. No significant difference was shown between the groups regarding operation time, intraoperative blood loss, intraperative blood transfusion, tumor resection margin,liver resection volume,(P>0.05). Length of incision has significant difference between the groups (P<0.05).2. Two groups of patients postoperative white blood count,C-reactive protein, Aspartate aminotransferase,Alanine aminotransferase lifts quickly, peak after the first day, the second day began to decline. Compared with OPH, all above index LPH rise significantly slower, fell at a significantly faster, the seventh day after surgery can achieve preoperative level. Two groups are statistically significant difference in the first day, second day, third day, fifth day after surgery (P<0.05), No difference in the seventh day (P>0.05).3. Compared with OPH, LPH group was shown significantly earlier regarding the Oral intake time and first time off the bed after surgery,The time withdrawing tube(P<0.05). LPH group was smaller regarding incision (P<0.05); In the LPH group, the mean hospital stay was significantly shorter than in OPH group (P<0.05);The total hospital cost of LPH group was higher than OPH groups (P<0.05). Conclusion:1. Choosing appropriate patient, laparoscopic precise hepatectomy is feasible, safe;2. Laparoscopic precise hepatectomy has the advantages of small trauma and postoperative recover quickly.3. Laparoscopic precise hepatectomy hospitalization fees higher than open precise hepatectomy4. Laparoscopic precise hepatectomy is worth popularizing.