| Objective:To explore the clinical efficacy of Precision Liver Surgery(PLS)theory in liver resection for patients with primary liver cancer and its effect on postoperative recurrence rate and survival rate.Methods:From September 2018 to September 2020,ninety-eight patients with PLC who underwent hepatectomy in the First Affiliated Hospital of Gannan Medical university were retrospectively analyzed.The 2019 version of the diagnostic criteria for primary liver cancer were used as the inclusion criteria,and they were divided into 2 groups according to surgical methods,Precision Liver Resection(PLR)and Traditional Liver Resection(TLR).PLR,no blockage or regional blockage of the blood flow into the liver,supplemented by ultrasound positioning during the operation,and the use of precision liver parenchyma cutting instruments to control the reduction of central venous pressure(CVP)before cutting the liver parenchyma.The pipelines encountered in the process of isolating the liver parenchyma are ligated one by one until the lesions are completely removed,and the wound surface is not sutured.After surgery,the concept of enhanced recovery surgery is followed.TLR: Pringle method was used to block the first hepatic hilum,the blocking method was "15+5" mode,the pre-cut line was marked with electrocautery about 2cm from the edge of the tumor,and the liver was cut by clamp method.Controlled reduction of CVP was not used before the liver parenchyma was severed,and the liver section was closed and sutured.After surgery,the routine postoperative care is followed.Observation indicators were(1)Basic information: gender,age,tumor diameter,liver cirrhosis,HBs Ag,Child grade,tumor number and location,Alpha-fetoprotein,preoperative transaminase and preoperative total bilirubin level,etc.;(2)Surgical indicators: operation time,blood loss,and blood transfusion;(3)Postoperative indicators: post-operative complications,hospitalization time,hospitalization expenses,liver function indexes at 1,3,and 5days after operation;(4)Follow-up status: tumor recurrence rate and patient survival rate at 1 year after operation.SPSS20.0 was used for statistical analysis of the collected data,and P<0.05 was considered statistically significant.Result:Ninety-eight patients who met the criteria were enrolled in this study,including the PLR group(n=46)and the TLR group(n=52).There were no significant differences in preoperative data including gender,age,tumor length,liver cirrhosis,HBs Ag,Child-Pugh grade,tumor number and location,AFP,ALT,AST,and TBIL levels between the two groups(P> 0.05),which is comparable.In terms of surgical indicators,in the PLR group,38 patients underwent laparoscopic precise hepatectomy,and 8 patients underwent open surgery.In the TLR group,37 patients underwent laparoscopic traditional liver resection,and 15 patients underwent open surgery.There was no significant difference in the surgical methods between the two groups,and there was no statistical significance(P>0.05).The blood transfusion and hospitalization costs between the two groups were no statistical significance(P>0.05).In terms of operation time,intraoperative blood loss,and postoperative hospital stay,the PLR group was significantly lower than the TLR group(t=-3.558,-3.081,-2.572;P=0.001,0.003,0.012).In terms of postoperative complications,a total of 9 patients in the precision group had complications after surgery(including 1 case of liver failure,5 cases of ascites,1 case of biliary fistula,4 cases of pulmonary infection,and 1 case of incision infection),and the complication rate was 19.57%.A total of 22 patients in the traditional group had complications after surgery(including 5 cases of liver failure,6 cases of ascites,1 case of biliary fistula,6 cases of pulmonary infection,and 5 cases of incision infection),and the complication rate was 42.3%.The incidence of complications in the PLR group was lower than that in the TLR group(χ2=5.837,P=0.016).The postoperative recovery time of liver function in the PLR group was significantly better than that in the TLR group,and the serum AST level in the PLR group was significantly lower at 1,3,and 5 days after operation in the TLR group,the difference was statistically significant(158.96±148.14 U/L vs 320.69±294.58 U/L,P=0.001,101.94±97.303 U/L vs 170.92±125.18 U/L,P=0.003,and 55.89±34.33 U/L vs 87.60±62.78 U/L,P=0.002).ALT in the PLR group was lower than that in the TLR group on the 1st and 3rd days after surgery,and the difference was statistically significant(165.72±168.46 U/L vs 344.44±399.13 U/L,P=0.005,and 68.93±54.06U/L vs 103.89±100.18 U/L,P=0.037).TBil in the PLR group was lower than that in the TLR group on the 1st and 3rd days after surgery,and the difference was statistically significant(20.88±10.29 U /L vs 42.87±77.91 U/L,P=0.049,and 19.16±8.64U/L vs 33.35±48.18U/L,P=0.042).The ALT and TBil in the PLR group were lower than those in the TLR group on the 5th day after surgery,but the difference was not statistically significant(P>0.05).After 1 year of follow-up,3 patients in the PLR group were lost to follow-up at 6,9,and 11 months after operation,3 patients in the TLR group at 3,4,and 6 months after operation,3 patients in the PLR group were lost to follow-up at postoperative 2nd month,3 and 6 months at surgery,the tumor recurrence rate was 7.0%(3/43)at 1 year after surgery.The TLR group of 10 patients recurred at 1,2,3,5,and 6 months after surgery,with a recurrence rate of 20.4%(10/49),there was no significant difference in recurrence rate between the two groups(P=0.065).In terms of 1-year survival rate,the PLR group was significantly higher than the TLR group,and the difference was statistically significant(P=0.028).Conclusions:The use of PLR in patients with PLC is safe and effective.PLR can significantly reduce intraoperative bleeding,shorten the operation time,reduce the trauma to the patient,make the postoperative liver function recover faster,so as to minimize the occurrence of complications,improve the 1-year survival rate of the patient,and has a good short-term Efficacy,is a recommended method of liver resection. |
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