The Clinical Study Of First Hepatic Portal Occlusion And Selective Hepatic Vascular Occlusion In Hepatectomy

Objective:HCC at this stage is dangerous to human health of one of the malignant tumor,liver resection is an effective means of treatment of liver cancer,but the bleeding in hepatic surgery is an important factor of restricting the hepatic surgery,therefore,the block into the hepatic blood flow becomes the necessary link of liver resection at this stage the main block the way for the first clinical application of hepatic door block and selective hepatic blood flow blocking,by comparing the first affiliated hospital of guangxi medical university liver and gallbladder surgery in June 2014 to December 2016,respectively,using the first porta hepatis blocking method and selective half liver blood flow blocking method for liver cancer resection of hepatocellular carcinoma in patients with ischemic time,intraoperative blood loss,postoperative changes of liver function,in order to understand the advantages and disadvantages of two groups of blocking method,for the clinical application of hepatic blood flow block to give a better choice.Methods: According to 63 cases of successful hepatectomy which are made by Guangxi University of traditional Chinese Medicine First Affiliated Hospital's doctors between June 2014 December to December2016,the patients were divided into two groups with the operation mode,the first Pringle group(n=32)and selective hepatic inflow occlusion group(n=31).In the first hepatic portal occlusion group,Pringle was used to block the inflow of hepatic blood flow,and the selective hepatic blood flow occlusion group was treated with selective hepatic vascular occlusion.Surgical resection of the two groups of patients were based on the image of the tumor location and the anatomical structure of the liver to clear the scope and boundaries of surgical resection,intraoperative intravenous inhalation anesthesia,the right upper quadrant or right subcostal incision into the abdominal cavity,abdominal exploration and liver,free hepatic ligament,clear tumor size,location,and water the portal vein blood relationship.Intraoperative use of hemostatic forceps gradually along with liver parenchyma of intrahepatic vascular and biliary forceps,cut,suture,and resection of the tumor(>1cm margin)and the surrounding satellite lesions,clear the vascular invasion.Abdominal drainage was performed after abdominal surgery.Routine anti infection,fluid replacement and anti viral therapy were used to support the treatment.Before the operation were compared between the two groups of albumin,prothrombin time,total bilirubin,platelet count,liver function Child-Pugh grade,tumor size,tumor number,compared two groups of patients with operation time,blood occlusion time,amount of bleeding.The 7 day after operation were compared between the two groups of third,albumin,prothrombin time,total bilirubin,alanine aminotransferase,aspartate aminotransferase.SPSS17.0 software was used for data analysis and processing.Results:(1)Before operation,there was no significant difference between the two groups in gender,age,preoperative albumin,preoperative PT,hypoalbuminemia,preoperative total bilirubin,preoperative Ptl,tumor number and size of primary tumor(P>0.05).(2)During the operation,the two groups in the blocking time have significant difference(P<0.05),the first hepatic portal occlusion group was better than that of selective hemihepatic blood flow occlusion group;the differences of two groups have no statistically significant in the amount of bleeding,operation time(P>0.05).(3)After operation,two groups of third days,seventh days,TB albumin and PT comparison,P values are greater than 0.05,there was no significant difference between the two groups;comparison of the two groups within 24 hours after AST,ALT,P values are greater than 0.05,there was no significant difference between the two groups after operation;seventh days ALT were compared,no significant difference between the two groups(P>0.05);comparison of AST seventh days after operation in the two groups,there was significant difference between two groups(P<0.05),on the seventh day after operation AST,Pringle group was better than that of selective hemihepatic blood flow occlusion group.Conclusion:(1)To compare with the first hepatic portal occlusion group and selective hemihepatic blood flow occlusion group,there are no significant advantages in the intraoperative bleeding volume,operation time,postoperative recovery of albumin,postoperative PT,postoperative TB.(2)In the operation time,the first hepatic portal blocking group was less than that of the selective half hepatic blood flow occlusion group,and in the postoperative liver cell damage,the first hepatic portal occlusion group was less than that of the selective hepatic vascular occlusion group.(3)Review clinical data and surgical procedure found in both groups,the first porta hepatis group blocking tumor located in the left half liver,more selective and half liver tumor in blood group is located in the right half liver,blocking time also has a gap at the same time,this is the seventh day after the AST a statistically significant results.