Study On The Application Of Combined Anatomical Segmentation In The Treatment Of Hepatocellular Carcinoma With Anatomical Hepatectomy

Objective:In combination with clinical cases,the efficacy of hepatectomy with different liver anatomical sub-fractions in the treatment of liver cancer was compared to select suitable surgical methods and achieve better therapeutic effects.Methods:We retrospectively analyzed the clinical data of 56 patients undergoing hepatectomy for primary liver cancer from January 2013 to September 2017 in our department.Among them,19 patients underwent conventional hepatectomy,that is Couinaud segmented hepatectomy(group A),and 37 patients underwent combined hepatic resection with various anatomical subsections,anatomical liver resection was performed using the Takasaki subsection method and Long Chongzheng subsection method(group B).Observe the indicators of the two groups of patients:(1)Preoperative general conditions:age,gender,proportion of patients with cirrhosis associated with hepatitis,preoperative total bilirubin,aspartate transaminase,alanine transaminase levels,15 minutes retention rate of phthalocyanine green,tumor size;2)Intraoperative conditions:operative time,intraoperative blood loss,and resection range.(3)Postoperative conditions:Levels of total bilirubin,aspartate aminotransferase,alanine aminotransferase,postoperative complications,and length of stay on days 1,3,and 7;(4)Prognosis:All patients were reviewed retrospectively.The review time was once every 3 months in the first year of the surgery,every 4 months in the second year,and once every six months thereafter.The follow-up deadline was December 1,2017,to understand the tumor recurrence,mortality,overall survival,etc.Results:No deaths occurred in either group.There was no statistically significant difference between the two groups in terms of age,gender,proportion of patients with liver cirrhosis,preoperative liver function,and tumor size(P>0.05).Two.groups of patients were treated with surgery.The operation time in group A was longer than that in group B,and the intraoperative blood loss in group B was less than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in the extent of resection between the two groups(P<0.05).Differences in total bilirubin between the two groups on the 1st,3rd,and 7th days after surgery were not statistically significant(P>0.05).There was no significant difference in the alanine transaminase and aspartate transaminase between the two groups on the first postoperative day(P>0.05).There was no significant difference in aspartate transaminase between the two groups on the third day after operation(P>0.05),but the difference in alanine transaminase was statistically significant(P<0.05).The difference in alanine transaminase and aspartate transaminase between the two groups on the 7th day after operation was statistically significant(P<0.05).The hospital stay in group B was shorter than that in group A(P<0.01),and the difference was statistically significant.There was no significant difference in postoperative complications between the two groups(P>0.05).There was no significant difference in the follow-up time,postoperative recurrence,and postoperative death between the two groups(P>0.05).Conclusions1.Both the Takasaki subsection method and the Long Chongzheng subsection method were developed on the basis of Couinaud..2.The combination of multiple anatomic segmented liver resection group is easier to operate,with less intraoperative blood loss and faster recovery.3.For the resection of hepatocellular carcinoma with bile duct or vascular invasion,it is still necessary to use the Couinaud segmented hepatectomy.4.Chong Chong Zheng is more suitable for the requirement of precise hepatectomy for liver resection of the right liver area.