【Abstract】ObjectiveTo explore the appropriate surgical management of the primary hepatocellular carcinoma with hypersplenism. MethodsOf 67 patients who has primary hepatocellular carcinoma with hypersplenism, 17 cases had hepatectomy combined with splenectomy, 7 cases had hepatectomy only, and the other 43 patients were treated with hepatic artery embolization and splenic artery embolization. ResultsThe symptoms of hypersplenism disappeared and the hemogram became normal 30 d after operation in 17 patients who had hepatectomy combined with splenectomy, but worsened in 7 patients who only had simple hepatectomy and 6 cases of those patients were treated with splenic artery embolization 3-7 months after operation. In 43 patients treated with hepatic artery embolization and splenic artery embolization, 79%（34/43）had improved hypersplenism symptoms and the hemogram became normal. ConclusionThe treatment of primary hepatocellular carcinoma with hypersplenism should be strived for hepatectomy combined with splenectomy. If the liver mass cannot be resected, hepatic artery embolization and splenic artery embolization should be chosen.
ObjectiveTo investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.MethodsThe clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were grouped according to different surgical procedures, 21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group, and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group. The operation time, intraoperative bleeding volume, postoperative hospital stays, liver function recovery, and postoperative complications were compared between the two groups.ResultsThere was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time (P>0.05), but the postoperative hospital stays in the observation group shortened (P=0.025). The changes on the ALT, TB, and AST in the observation group was obvious than those of the control group (P<0.05). There was no statistically significant incidence between the two groups in the total incidence of complications (P=0.128).ConclusionsCompared with Pringle method of total hepatic vascular exclusion, descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers, and it is convenient to implement hemihepatic blood flow occlusion. It has less damage to healthy side of the liver and quicker liver function recovery, and it can reduce postoperative complications and shorten postoperative hospital stay.
Objective To state operative details of lip-shaped hepatectomy (LSH) and evaluate its advantage in treatment of primary liver cancer (PLC).Methods LSH is one of the irregular hepatectomies. The key lies in the following five operative kinks: ①adequately mobilizing perihepatic ligaments; ②designing lip-shaped hepatic incision; ③laying sutures on both sides of the hepatic incision for traction; ④wedge-shapedly resecting the tumor and the surrounding liver; ⑤closely sewing up the hepatic cutting surface.Results Two hundreds and thirty three patients with PLC were treated by LSH between Oct. 1991 and Dec. 1997 in Zhongshan hospital, Shanghai medical university. Among them 8 cases underwent initial hepatectomy and resection for recurrence of the tumor. The operative mortality rate was 1.2%, 2 died of hepatic failure and 1 renal failure. In addition to bile leakage in 3 cases and hydropsy at the operative area in one case, no severe postoperative complications were found, such as intraperitoneal bleeding, subphrenic abscess and so on. The 1-,3-,5-year survival rates were 89.8%, 64.3% and 55.9% respectively, in 233 patients with 241 LSHs. 25 patients survived more than 5 years. The result indicated that the most advantage of LSH was to increase operative safety on the basis of guarantee of radical resection of PLC, especially to decrease some complications from hepatic cutting surface.Conclusion LSH is a relatively simple, safe, reasonable and recommendable hepatectomic modality.
目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
Objective To systematically evaluate the efficiency of laparoscopic hepatectomy（LH） and conventionalopen hepatectomy （OH）in patients with hepatocellular carcinoma （HCC）. Methods The literatures about the therap-eutic effect of LH and OH on hepatocellular carcinoma were collected from PubMed， Chinese Journal Full-text Database （CJFD）， Wanfang Database， China Doctor/Master Dissertations Full-text Database （CDMD）， and China Proceedings of Conference Full-text Database （CPCD）from 2000 to 2011. RevMan 5.0 software was used for data analysis. Results Eleven controlled clinical trials were included in this analysis. These studies included a total of 781 patients：325 treated with LH and 456 treated with OH. The results of meta-analysis showed that LH group had shorter operation time〔WMD=-20.85， 95% CI （-29.54， -12.16）， P＜0.000 01〕， less operative blood loss 〔SMD=-0.42，95% CI（-0.65，-0.19）， P=0.000 4〕， a lower postoperative morbidity rate 〔OR=0.43，95% CI （0.28，0.65），P＜0.000 1〕， and shorter hospitalization days 〔WMD=-4.32，95％ CI （-6.29，-2.34），P＜0.000 1〕 than OH group. There was no significant difference in postoperative recurrence （P=0.80）， overall survival in 1-year （P=0.98）， 3-year （P=0.41）， and 5-year （P=0.12）， and in disease-free survival in 1-year （P=0.15）， 3-year （P=0.62）， and 5-year （P=0.99）between the two groups. Conclusions For the patients with hepatocellular carcinoma localized to the CouinaudⅡ，Ⅲ，Ⅳ，Ⅴ，and Ⅵ segments with a maximum lesion size of 5cm， as well as the tumor has no effect on the exposure of blood vessel of the first and second hepatic portal， and the liver functions are classified as Child B or A high grade， the laparoscopic liver resection is priority considered in the conditions allow.
Objective To approach whether the postoperative recovery processes of the living donors and hepaticpatients after right hepatectomy is similar. Methods The clinical data of consecutive cases from 2009 to 2010 in our liver transplantation center was retrospectively analyzed， including 40 cases who donated the right lobe without the middlehepatic vein （living donor liver transpalntation-donor group， abbreviated as LDLT-D group） and 80 hepatic patients forright hepatectomy， in which 40 cases were hepatic patients without cirrhosis （liver disease-noncirrhosis group， abbreviatedas LD-NC group） and 40 cases were hepatic patients with cirrhosis （liver disease-with cirrhosis group， abbreviated asLD-WC group）. Preoperative liver function and general clinical data， intraoperative blood loss and transfusion， postoper-ative liver function， and complications were statistically analyzed in this study. Results The preoperative parameters of three groups were comparable. LDLT-D group experienced more intraoperative bleeding than LD-NC group 〔（765±411） mL vs. （584±242） mL， P=0.008〕， and was similar to LD-WC group 〔（666±224） mL， P=0.136〕. However， the average amount of blood transfusion products was similar among the 3 groups （P=0.108）. The levels of total bilirubin and INR of LDLT-D group were higher than LD-NC group and LD-WC group on the first and third day after operation （P＜0.05）. The levels of ALT and AST of LD-WC group were higher than LDLT-D group and LD-NC group （P＜0.05）. The overall postoperative surgical morbidity incidence of LDLT-D group， LD-NC group， and LD-WC group were 30.0%（12/40）， 27.5% （11/40）， and 37.5% （15/40） respectively， and were not statistically significant （P=0.606）. However， the ClavienⅢcomplication rate of LD-WC group was higher than LDLT-D group and LD-NC group 〔27.5% （11/40） vs. 7.5%（3/40） and 10.0% （4/40）， P=0.024〕. Conclusions Liver function of living donors is injured more seriously during the early postoperative period. The total complication rates after right hepatectomy are similar among the living liver donation and hepatic patients with or without cirrhosis. However， the serious complication rate of cirrhotic liver recipients is higher than living donors and patients without cirrhosis.
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.