Comparative Study Of Different Hepatic Flow Occlusion Techniques In Perioperative Period Of Laparoscopic Left Hemihepatectomy For Primary Liver Cancer

Objection:To compare the perioperative effects of different hepatic flow occlusion techniques in laparoscopic left hemihepatectomy for primary liver cancer,and to explore the most appropriate hepatic flow occlusion techniques and promote their application.Method:The medical records of 195 patients with primary liver cancer who were admitted to the department of hepatobiliary and Pancreatic surgery of our hospital from April 2014 to October 2018 and planned to performed laparoscopic left hemihepatectomy were retrospective analysid.The Patints were divided into three groups according to the intraoperative hepatic flow occlusion techniques:Group A?86 cases adopting Pringle method?,group B?64 cases adopting hemihepatic flow occlusion?,group C?45 cases adopting hemihepatic flow occlusion plus hepatic vein control?;patients who successfully underwent laparoscopic left left hepatic resection were divided into the corresponding A₁?B₁?C₁ groups according to whether they transferred to laparotomy or not.Comparing the difference of preoperative general data?age,gender,preoperative liver function grading,tumber number and size?,intraoperative conditions?transfer open rate,operation time,intraoperative blood loss,blood transfusion rate?,and postoperative situation?liver function,complications,perioperative mortality,rate of abdominal bleeding,aeration time,drainage tube indwelling time and hospital stay?among the three groups.Result:There was no significant difference in age,gender,preoperative liver function grade,tumor number and size among the three groups,P>0.05.Among the 195 cases of laparoscopic left hemihepatectomy,12 patients were transferred to open hepatectomy,including 5 cases in group A?5.8%?,4 cases in group B?6.3%?and3 cases in group C?6.7%?,the remaining 183 cases were all successfully completed laparoscopic left hepatectomy,there was no significant difference in the conversion rate between the three groups?P>0.05?.The operative time of the patients in the A₁?B₁and C₁ groups was 197±45 min?203±51 min?210±56 min,respectively,and the difference was not statistically significant,?P>0.05?.Intraoperative blood loss in group C₁ was significantly lower than that in group A₁ and B₁?156±41 vs 238±51,207±46?ml,P^ac<0.05,P^bc<0.05;and the intraoperative transfusion rate of group C₁ was the lowest(4.8%vs 10.0%,11.8%;P^ac<0.05,P^bc<0.05).Serum levels of alanine aminotransferases,aspartate aminotransferase and total bilirubin were compaed between groups A₁?B₁?and C₁ at 1?4?7 days after surgery,the levels in group A₁ were significantly higher than those of group B₁ and C₁,(P^ab<0.05,P^ac<0.05);while postoperative serum prealbumin level in group A₁ were significantly lower than in group B₁ and C₁,(P^ab<0.05,P^ac<0.05).The incidence of postoperative complications in group A₁ was significantly higher than that in group B₁and C₁(23.7%vs 11.7%,7.1%,P^ab<0.05,P^ac<0.05).Postoperative liver failure occurred in 3 patients?3.7%?in group A₁,and 1 patients?1.7%?in group B₁,while no postoperative liver failure occurred in group C₁;and 1 patients in group A₁ died of postoperative liver failure.No active massive abdominal bleeding after surgery.Group A₁ in patients with Postoperative subphrenic abscess?biliary leakage and equal or above in ascites were higher than inB₁?C₁ group(P^ab<0.05,P^ac<0.05),of which the A₁ group respectively 3 cases?5 cases and 4 cases?3.7%?6.2%?4.9%?,B₁respectively 1 cases?3 cases and 1 cases?1.7%?5%?1.7%?and C₁ respectively 0cases?2 cases and 1 cases?0%?4.8%?2.4%?.There were 2 cases?2.6%?,1 case?1.7%?and 1 case?2.4%?of A₁?B₁ and C₁ in three groups with moderate or above pleural effusion,respectively.,and there was no significant difference among the three groups?P>0.05?.Group C₁ was superior to A₁ and B₁ groups in postoperative ventilation time,drainage tube indwelling time and hospitalization time.Conclusion:1?Pringle method?hemihepatic flow occlusion technique?hemihepatic flow occlusion plus hepatic vein control technique can effectively control intraoperative hemorrhage in laparoscopic left hemihepatic resection for primary liver cancer;2?In the treatment of primary liver cancer by laparoscopic left hemihepate-ctomy,hemihepatic flow occlusion plus hepatic vein control technique has the best postoperative protective effect,the least postoperative complications,the shortest hospitalization time and fastest postoperative recovery,which can achieve the best perioperative outcomes for patients and is worthy of promotion and application.