The Application Of Selective Hepatic Inflow Control In Laparoscopic Hepatectomy

Background:Laparoscopic liver resection has many advantages: reduced postoperative pain,shorter hospital stay, reduced postoperative adhesions, accelerated postoperativerecovery, reduced abdominal scar. The implementation of the world’s firstlaparoscopic liver resection since1991, the reports of laparoscopic liver resectionwere increasing exponentially. The supply of hepatic blood are very rich, theperfusion system has two sets which are hepatic artery and portal vein. So,bleedingcontrol was the key to success of laparoscopic liver resection, how to choose a safeand effective method of hepatic inflow vascular occlusion is very important.Objective:A retrospective comparison of intermittent Pringle maneuver and selectivehepatic inflow control, analyze their differences in conditions of intraoperative andpostoperative, and to explore the advantages of two methods in operation,thelimitations and the impact on patients, etc. And choose the more appropriate methodsin laparoscopic hepatectomy.Methods:A retrospective analysis of53cases of laparoscopic hepatectomy, Groupingaccording to the different methods: Group A(22cases) which is intermittent Pringlemaneuver,Group B (31patients) which is selective hepatic inflow control. Wecompared their operative time, blood loss, postoperative liver function, postoperativehospital stay and complications. Using the chi-square test analysis of the preoperativegeneral information and postoperative complications, using two-sample t-test analysisof operative time, blood loss, postoperative liver function and postoperative hospitalstay, Calculated using SPSS19.0statistical software, with α=0.05level for the testlevel.Results:1.General situation: two groups of patients which age distribution, sex ratio, withor without cirrhosis of the liver, Child-Pugh classification, preoperative liver function showed no significant difference.2.Intraoperative situation: In operative time,the differences between the twogroups was not statistically significant, Group Aof blood loss was less than in GroupB.3.Postoperative situation: In ALT, AST levels,Group A of the1st,3rdand7thpostoperative days were higher than Group B.TBIL level of postoperative, thenumber of postoperative hospital stay and complications was no significantdifference.Conclusion:1.Selective hepatic inflow control in laparoscopic hepatectomy is safe andfeasible;2.Intraoperative blood loss of the selective hepatic inflow occlusion is slightlyhigher than intermittent Pringle maneuver, but its protection of liver function is betterthan intermittent Pringle maneuver.