Objective To evaluate the short-term effectiveness and safety of laparoscopic versus conventional open left hepatectomy. Methods Databases including CENTRAL (Issue 1, 2012), MEDLINE/PubMed (1978 to 2012), EMbase (1966 to 2012), CBM (1978 to 2012), CNKI (1979 to 2012) and the Chinese Medical Association Figures Journal Systems (1990 to 2012) were searched to collect clinical trials on laparoscopic versus conventional open left hepatectomy. Relevant proceedings and references of the included studies were also retrieved manually. According to the inclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then meta-analysis was conducted using RevMan5.0 software. Results No randomized controlled trials were collected, and a total of 5 clinical concurrent controlled trials involving 319 patients were included finally. The results of meta-analysis showed that, compared with the conventional open group, the laparoscopic group was longer in the operation time (WMD=40.89, 95%CI 29.39 to 55.38, Plt;0.000 01), and was lower in the intraoperative blood loss (WMD=−107.84, 95%CI −208.96 to −6.73, Plt;0.04); but there was no significant difference between the two groups in terms of hospital stays (WMD=−3.78, 95%CI −9.60 to 2.04, P=0.20) or postoperative complications (WMD=0.69, 95%CI 0.37 to 1.29, P=0.25). Conclusion As a minimally invasive technique, laparoscopic left hepatectomy has advantages of small abdominal incision and less intraoperative blood loss, and it is helpful to improve the quality of life for patients. Due to the limitation of quantity and quality of the included studies, it is hard to estimate the impact of bias on the reliability of this conclusion. We advise to perform more high quality, large scale and multicenter studies with adequate follow-up in the future.
Objective To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatocellular carcinoma (HCC). Methods Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library (Issue 3, 2012) were searched to collect the randomized controlled trails (RCTs) and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that: Compared with OH, LH had lesser amount of intraoperative bleeding (MD=?144.09, 95%CI ?194.25 to ?93.94, Plt;0.000 01), shorter hospital stay (MD=?5.48, 95%CI ?7.10 to ?3.85, Plt;0.000 01), and lower postoperative complications (OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1). But there were no differences between the 2 groups in operation time (MD=?0.64, 95%CI ?22.95 to 21.68, P=0.96), perioperative death rate, 3-5 year survival rate, and tumor free survival rate. Conclusion LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.
目的 探讨白试验在肝切除手术中检测漏胆的价值。方法 笔者所在医院2008年1月至2013年1月期间在肝切除手术中采用白试验联合干纱布擦拭法检测漏胆56例。即在肝切除手术操作末期，用干纱布擦拭法确认无漏胆后，经胆囊管或左右肝管插管注入5%无菌脂肪乳剂10～30mL，同时用手阻断远端胆总管。观察肝切除手术创面的白色液体渗出情况，对渗出白色液体处予以间断缝合。重复操作，至断面无白色液体渗出为止。结果 56例患者经术中检测，发现漏胆17例（漏胆检出率为30.4%），每例发现漏胆1～6处（平均2.9处），术中均予以确切缝合以关闭漏胆处，且重复试验操作，证实均再无漏胆。术后发生漏胆2例（3.6%），经相应治疗后痊愈出院。全部患者出院后均随访3～6个月（平均3.8个月），无膈下积液或膈下感染病例发生。结论 术中白试验能够发现漏胆的精确部位，不会污染肝切除手术创面，并能够无限次地重复试验，值得临床推广。
ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
ObjectiveTo explore the curative effect of precise hepatectomy techniques in hepatolithus. MethodsTotally 132 patients underwent precise hepatectomy and 52 patients underwent irregular hepatectomy were retrospectively analyzed, and the intraoperative and postoperative indexes such as operation time, blood loss, postoperative complications, hospitalization time, clearance rate of calculus, and cost of hospitalization were analyzed. ResultsCompared with the patients in irregular hepatectomy group, although the operative time was longer in precise hepatectomy group 〔(364.6±57.8) min vs. (292.9±44.7) min, Plt;0.001〕, but the patients in precise hepatectomy group had less blood loss 〔(558.3±90.6) ml vs. (726.7±88.7) ml, Plt;0.001〕, less postoperative complications (11.4% vs. 23.1%，P=0.004 3), and higher clearance rate of calculus (89.4% vs. 73.1%, P=0.005 5). Thus, the patients in precise hepatectomy group had shorter hospital stay 〔(22.9±4.4) d vs. (28.8±3.5) d, Plt;0.001〕 and less cost of hospitalization 〔(1.8±0.7)×104 yuan vs. (2.1±0.9)×104 yuan, P=0.016 5〕. Conclusion Precise hepatectomy is better than irregular hepatectomy in treatment for hepatolithus.
Objective To develop hepatic surgical planning software for hepatic operation on deciding the rational operational scheme and simulating procedures before the operation to accomplish the precise liver resection and decrease the operational risk. Methods3D-econstruction of liver was restored from spiral computed tomography (CT) data by using LiVirtue software. The liver and its anatomic structures were reconstructed to illuminate the location of the tumor and its related vessels to design a rational operational scheme. The virtul results, such as liver volume, hepatic sections, anatomy of portal vein and hepatic veins or possible operation plans, were compared with the actual situations during the operations. Results3D models of liver, tumor and their relative vessels were reconstructed successfully. Preoperative planning and intra-perative navigation based on the models ensured the safety of liver resection in our 32 cases of right lobe tumors. This preoperative simulation allowed surgeons to dissect the liver with reduced complications. These models could be also viewed and manipulated on personal computers.ConclusionThe LiVirtue is very helpful in the hepatic surgery, for clearly disclosing hepatic structures, rationally deciding operation schemes, virtually simulating the operations. This preoperative estimation from 3D model of liver benefits a lot to complicated liver resection.
目的 探讨原发性肝癌自发性破裂腹腔内出血的临床特点和手术治疗方法。方法 回顾性分析我院1998～2007年收治的53例经手术证实的原发性肝癌自发性破裂腹腔内出血患者的临床资料，结合文献复习进行讨论。结果 53例患者均以突发性腹痛为首发症状，有前期症状者33例，无症状者20例； 有外伤史者(左上腹或季肋区)6例； 有腹膜炎体征46例，腹腔穿刺抽出不凝血41例，合并休克29例。术前误诊16例。行急诊手术48例，施行肝切除33例。术后肝功能不全34例，其中3例死于肝功能衰竭。术后生存3 d～78个月，平均34.6个月。结论 原发性肝癌自发性破裂腹腔内出血多以腹痛为首发，常以血性腹膜炎表现为特点，术前误诊率较高； 手术方式根据病变位置、大小，肿瘤是否局限、转移和肝硬变程度决定。术后近期死亡原因主要是肝功能衰竭，远期死亡原因主要是复发转移。
Objective To report the authors’ own experience and results of recent studies of anatomical liver resection for patients with hepatocellular carcinoma (HCC). Methods From January 2004 to June 2005, anatomical liver resection procedure were completed in 93 patients with HCC. Surgical techniques were designed to reduce intraoperative blood loss, blood transfusion and postoperative complications by parenchymal crushing with kelly forceps, inflow and outflow selective clamping. In 13 patients with large liver tumors, liver hanging maneuver performed in the course of hemihepatectomy. Liver transection with intermittent closure of the blood influx to the liver, using a Pringle manoeuvre. Results Of 93 patients undergoing hepatectomy for HCC, underlying cirrhosis was present in 82 (88%) patients. The median blood loss was 300 ml (100－6 000 ml) and 71%（66/93） of the patients did not require blood transfusion.The postoperative complication rate was 34%（32/93）, complications were primarily subphrenic collection (8 cases). Within 30 postoperative days, no death was recorded. Conclusion The anatomical liver resection of HCC may be improve the surgical outcome.
Objective To investigate the clinicopathological features, postoperative survival and prognostic influencing factors of male patients with hepatocellular carcinoma （HCC）. Methods The clinicopathological features and the follow-up data of 155 male HCC patients who received hepatectomy from Jan. 1995 to Dec. 2002 were retrospectively analyzed and the prognostic influencing factors were defined by uni- and multi-variate analysis. Results Compared with 24 female patients at the same period, males were about six-year older and both of their hepatitis B surface antigen (HBsAg) and liver cirrhosis positive rates were higher (P＜0.05)， but there were no significant differences of the other clinicopathological parameters between the male group and the female group. Multivariate analysis showed that Edmondson-Steiner grade and portal vein tumor thrombosis (PVTT) were two independent prognostic influencing factors of both the overall survival and the tumor-free postoperative survival of male patients with HCC, while satellite nodule and tumor size only influenced the overall survival. Conclusion The main clinicopathological features and the postoperative survival of male HCC patients were similar than those of female’s. Tumor differentiation and biological behaviors were major factors affecting postoperative survival of male patients with HCC.