Application of round ligament fissure approach in re-hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Qing ,  GAO Fengwei , LIU Yu , XUE Qian , FU Jinqiang

Department of Hepatopancreatobiliary Surgery, Leshan People’s Hospital, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

GAO Fengwei, Email: 707850255@qq.com

Keywords：

recurrent hepatocellular carcinoma; round ligament fissure approach; re-hepatectomy; liver function; intraoperative bleeding

DOI：

10.7507/1007-9424.202012067

Video：

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Objective To investigate the effect of the round ligament fissure approach in re-hepatectomy.Methods A total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.Results Compared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).Conclusion Re-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.

Citation： WANG Qing, GAO Fengwei, LIU Yu, XUE Qian, FU Jinqiang. Application of round ligament fissure approach in re-hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 155-159. doi: 10.7507/1007-9424.202012067 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	龚奇, 徐锋, 赵亮, 等. ALPPS 术后肝再生与内质网应激 IRE1α-XBP1 通路的关系研究. 中国普外基础与临床杂志, 2019, 26(10): 1162-1169.
3.	胡泽明, 陈彪, 钟佳宁, 等. 原发性肝癌治疗方法的应用进展. 山东医药, 2019, 59(9): 106-110.
4.	张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
5.	肖朝辉, 刘荣. 肝癌患者术后复发分子标志物的临床研究进展. 中华肝胆外科杂志, 2017, 23(4): 277-281.
6.	邓小斌. 肝癌肝切除术后复发再手术治疗价值及术式选择. 临床外科杂志, 2017, 25(6): 429-430.
7.	刘袁君, 吴泓, 曾勇, 等. 腔镜超声联合荧光显像在腹腔镜肝切除术中的应用. 中国普外基础与临床杂志, 2020, 27(6): 662-665.
8.	孙科, 肖宏, 陈安平, 等. 肝圆韧带入路在腹腔镜再次胆道取石术中的应用价值. 中华消化外科杂志, 2019, 18(2): 160-164.
9.	Isetani M, Morise Z, Kawabe N, et al. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol, 2015, 21(3): 961-968.
10.	中华医学会外科学分会肝脏学组. 腹腔镜肝切除术专家共识 (2013 版). 中国肿瘤临床, 2013, 40(6): 303-306.
11.	朱武刚, 陆晓兰, 刘洪涛, 等. 肝癌根治术后辅助 TACE 疗效的 meta 分析. 介入放射学杂志, 2019, 28(9): 865-869.
12.	何生, 邓靖宇, 罗书画. 复发性肝癌再手术的疗效. 临床外科杂志, 2005, 13(3): 135-136.
13.	陈克霏, 唐友银, 贾贵清, 等. 复杂泡型肝包虫根治性肝切除的 MDT 讨论. 中国普外基础与临床杂志, 2018, 25(1): 77-82.
14.	Takagi C, Itano O, Yagi H, et al. Laparoscopic liver resection for patients with a history of upper abdominal surgery. HPB, 2016, 18: e313.
15.	杨明坤. 肝圆韧带入路的解剖性肝切除术. 西南国防医药, 2014, 24(9): 964-966.
16.	柴乃俊, 蒋泽斌, 赵慧琪, 等. 保留尾状叶肝次全切除治疗肝内胆管结石病. 中国普外基础与临床杂志, 2018, 25(2): 207-212.
17.	曹君, 陈亚进. 浅谈腹腔镜肝切除之入路. 中华外科杂志, 2019, 57(7): 503-507.
18.	Ibukuro K, Takeguchi T, Fukuda H, et al. Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver. Surg Radiol Anat, 2016, 38(9): 1061-1067.
19.	谭文勇, 罗强, 何平. 不同入路下行左肝外叶切除术对机体创伤应激反应程度及残余肝功能影响. 标记免疫分析与临床, 2018, 25(1): 44-49.
20.	申东方, 顾小晖, 漆道金, 等. 大鼠肝部分切除术后肝细胞生长因子、转化生长因子-β1 水平变化及脾动脉结扎对大鼠肝再生的影响. 中华实验外科杂志, 2019, 36(3): 455-457.
21.	方兆山, 杨剑, 庞珏, 等. 3D 腹腔镜 Glisson 蒂横断式肝切除术治疗肝癌对机体细胞免疫功能的影响. 实用医学杂志, 2018, 34(12): 2004-2006, 2011.
22.	陈熙, 胡朝辉, 彭永海, 等. 控制性低中心静脉压在腹腔镜肝切除中的应用: 前瞻性随机对照研究. 中国微创外科杂志, 2018, 18(7): 585-589.
23.	张胜龙, 杨先伟, 王文涛. 泡型肝包虫病肝切除术后胆漏发生危险因素分析. 中华普通外科杂志, 2020, 35(1): 26-29.
24.	徐亚男, 姜洪池. 肝门部胆管癌肝切除术后肝功能衰竭的危险因素及治疗策略. 中华普通外科杂志, 2018, 33(12): 1076-1078.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 龚奇, 徐锋, 赵亮, 等. ALPPS 术后肝再生与内质网应激 IRE1α-XBP1 通路的关系研究. 中国普外基础与临床杂志, 2019, 26(10): 1162-1169.
3. 胡泽明, 陈彪, 钟佳宁, 等. 原发性肝癌治疗方法的应用进展. 山东医药, 2019, 59(9): 106-110.
4. 张宇, 杨冲, 王燚, 等. 离体肝切除和自体肝移植联合复杂肝静脉重建治疗终末期肝泡型包虫病. 中国普外基础与临床杂志, 2018, 25(10): 1236-1241.
5. 肖朝辉, 刘荣. 肝癌患者术后复发分子标志物的临床研究进展. 中华肝胆外科杂志, 2017, 23(4): 277-281.
6. 邓小斌. 肝癌肝切除术后复发再手术治疗价值及术式选择. 临床外科杂志, 2017, 25(6): 429-430.
7. 刘袁君, 吴泓, 曾勇, 等. 腔镜超声联合荧光显像在腹腔镜肝切除术中的应用. 中国普外基础与临床杂志, 2020, 27(6): 662-665.
8. 孙科, 肖宏, 陈安平, 等. 肝圆韧带入路在腹腔镜再次胆道取石术中的应用价值. 中华消化外科杂志, 2019, 18(2): 160-164.
9. Isetani M, Morise Z, Kawabe N, et al. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol, 2015, 21(3): 961-968.
10. 中华医学会外科学分会肝脏学组. 腹腔镜肝切除术专家共识 (2013 版). 中国肿瘤临床, 2013, 40(6): 303-306.
11. 朱武刚, 陆晓兰, 刘洪涛, 等. 肝癌根治术后辅助 TACE 疗效的 meta 分析. 介入放射学杂志, 2019, 28(9): 865-869.
12. 何生, 邓靖宇, 罗书画. 复发性肝癌再手术的疗效. 临床外科杂志, 2005, 13(3): 135-136.
13. 陈克霏, 唐友银, 贾贵清, 等. 复杂泡型肝包虫根治性肝切除的 MDT 讨论. 中国普外基础与临床杂志, 2018, 25(1): 77-82.
14. Takagi C, Itano O, Yagi H, et al. Laparoscopic liver resection for patients with a history of upper abdominal surgery. HPB, 2016, 18: e313.
15. 杨明坤. 肝圆韧带入路的解剖性肝切除术. 西南国防医药, 2014, 24(9): 964-966.
16. 柴乃俊, 蒋泽斌, 赵慧琪, 等. 保留尾状叶肝次全切除治疗肝内胆管结石病. 中国普外基础与临床杂志, 2018, 25(2): 207-212.
17. 曹君, 陈亚进. 浅谈腹腔镜肝切除之入路. 中华外科杂志, 2019, 57(7): 503-507.
18. Ibukuro K, Takeguchi T, Fukuda H, et al. Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver. Surg Radiol Anat, 2016, 38(9): 1061-1067.
19. 谭文勇, 罗强, 何平. 不同入路下行左肝外叶切除术对机体创伤应激反应程度及残余肝功能影响. 标记免疫分析与临床, 2018, 25(1): 44-49.
20. 申东方, 顾小晖, 漆道金, 等. 大鼠肝部分切除术后肝细胞生长因子、转化生长因子-β1 水平变化及脾动脉结扎对大鼠肝再生的影响. 中华实验外科杂志, 2019, 36(3): 455-457.
21. 方兆山, 杨剑, 庞珏, 等. 3D 腹腔镜 Glisson 蒂横断式肝切除术治疗肝癌对机体细胞免疫功能的影响. 实用医学杂志, 2018, 34(12): 2004-2006, 2011.
22. 陈熙, 胡朝辉, 彭永海, 等. 控制性低中心静脉压在腹腔镜肝切除中的应用: 前瞻性随机对照研究. 中国微创外科杂志, 2018, 18(7): 585-589.
23. 张胜龙, 杨先伟, 王文涛. 泡型肝包虫病肝切除术后胆漏发生危险因素分析. 中华普通外科杂志, 2020, 35(1): 26-29.
24. 徐亚男, 姜洪池. 肝门部胆管癌肝切除术后肝功能衰竭的危险因素及治疗策略. 中华普通外科杂志, 2018, 33(12): 1076-1078.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of round ligament fissure approach in re-hepatectomy

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