A Control Study:the Clinical Effects Between Hepatic Left Lateral Lobectomy By Total Laparoscope And By Laparotomy In Living Donor Liver Transplantation

Objects:To investigate the viability of hepatic left lateral lobectomy by total laparoscope and compare the clinical effect of hepatic left lateral lobectomy by total laparoscope with that by laparotomy in living donor liver transplantation.Clinical material and methods:This study recruited 17 adults who offered living donor liver to children in the organ transplant institute of the general hospital of Chinese Armed Police Force from January 2014 to December 2016.Among those subjects,laparotomy group included 11 people and the rest belonged to laparoscope group.Before surgery,all subjects were routinely examined(blood routine,biochemistry,infectious disease screening,chest radiography,and electrocardiogram)and their livers were evaluated by living donor liver standard(texture,anatomic variation,and volume).Then,the subjects were operated using hepatic left lateral lobectomy by laparotomy or by total laparoscope.The baseline data(gender,age,height,and weight)and clinical recovery data(operative time,intraoperative blood lose,length of hospital stay,warm ischemia time of donor liver,duration time of postoperative incision pain intensity higher than 5 scores,operative complications of donors,hospital cost,and operative complications of transplant liver)were analyzed statistically.Data within 7 days after surgery,including blood routine(WBC,HGB,PLT),hepatic biochemistry(ALT,AST,ALP,GGT,TBIL,ALB,CHE),CRP,and PT,were collected.Measurement date were shown as mean ± standard deviation.The rank sum test was analyzed using IBM SPSS statistics 22.Enumeration data were analyzed using fourfold table chi-square test.When P<0.05,differences were statistically significant.Results:Donors from two groups were operated successfully.In baseline data,gender(3 males,3 females;6 males,5 females.),age(32±12y;30±12y),height(163±13cm;164±11cm)and weight(58.5±13.5kg;63.5±21.5kg)showed no significant differences between laparotomy group and laparoscope group(P=1.000,P=0.343,P=0.893,P=0.463).No operative complications were shown in both two groups.Intraoperative blood loss(173 ± 37m;209±91ml),warm ischemia time of donor liver(5.17±1.17min;4.18± 1.82min),rate of bile leakage in transplant liver fracture surface(16.67%;18.18%)showed no significant differences(P=0.753,P=0.414,P=1.000).Operative time(471 ± 176min;327±333min),length of hospital stay(3.5±0.5d;13.27±5.73d),duration time of postoperative incision pain intensity higher than 5 scores(7.83±4.17h;29.36±15.64h),and hospital cost(56014.17±4198.83 RMB;29199±381 RMB)showed significant differences(P=0.028,P=0.027,P=0.028,P=0.028).Data within 7 days after surgery,including blood routine(WBC,HGB,PLT)(P=0.344,P=0.075,P=0.345)and hepatic enzymes(ALB,ALP)(P=0.345,P=0.753),showed no significant differences.But data including CRP,ALT,AST,GGT,TBIL,CHE,and PT between two groups showed significant differences(P=0.028,P=0.028,P=0.046,P=0.046,P=0.046,P=0.028,P=0.043).In acceptors,graft and recipient one year cum survival rate was 83.3%,83.3%in laparoscope group and 90.9%,90.9%in laparotomy group,which showed no difference between two groups(p=0.653,p=0.653).Conclusions:Hepatic left lateral lobectomy by total laparoscope can be operated in China.Though its operative time was longer,and its intraoperative blood loss and warm ischemia time were similar to hepatic left lateral lobectomy by laparotomy,it was proved to have some advantages over hepatic left lateral lobectomy by laparotomy,including quick recovery,short length of hospital stay,light incision pain and small incision scar.Therefore,it is worthy of applying to clinic.