| Objective To evaluate the clinical application of precise hepatectomy in treatment of large hepatocellular carcinoma.Methods The clinical data of 165 patients with hepatocellular carcinoma who were underwent curative hepatectomy from July 2009 to July 2013 at Anhui Provincial Hospitalwere retrospectively analyzed. Eighty-two patients received traditional hepatectomy (traditional group) and 80 patients receievd precise hepatectomy (precise group). Laboratory tests (such as blood routine, biochemical and coagulogram), B ultrasound, CT and MRI were used to evaluate the condition of tumor and patient general condition in traditional group. The model of the liver, hepatic artery, hepatic vein, and portal vein was rebuilt by 3D virtual surgery planning system according to thin layer CT image data and the standard liver volume, resection of liver volume, residual liver volume and residual liver volume percent were calculated. Furthermore, intraoperative B-mode ultrasound was used to observe the tumor location, size and the relationship between tumor and surrounding tissue. Intraoperative and postoperative conditions and the results of follow-up of patients in the two groups were compared.Results The rate of hepatic blood flow occlusion of the routine group and the presice group were 52.4% and 36.2%, respectively, with a significant difference between the two groups (x2=4.29%, P=0.038).Blood loss was (298.7±315.1) in the routine group and (206.8±173.7) in the precise group, with a significant difference between the two groups(t=2.291, P=0.001). Rate of blood transfusion of the routine group and the presice group were15.8% and 8.5%,with no significant difference between the two groups (x2=.888, P=0.169).The postoperative levels of ALT (alanine transaminase) at the first day, the third day and the fifth day were (683.2±507.4) U/L, (243.0±213.4) U/L and (97.2 ±75.7) U/L in the routine group, and (472.4±312.0) U/L, (164.3±147.0) U/L and (58.8±50.8) U/L, with a significant difference between the two groups (t=3.174,2.729,3.772,P=0.021,0.019,0.000). The length of stay in the routine group and the presice group were (15.5±5.7) d and (14.4±4.9) d, respectively, with no significant difference between the two groups (t=1.309, P=0.534), but the postoperative length of stay in the routine group and the presice group were (8.9±3.4) d and (7.9±2.3) d, respectively, with a significant difference between the two groups (t=2.161, P=0.031). The rate of postoperative morbidity of the routine group and the presice group were 37.8% and 17.5%, respectively, with a significant difference between the two groups (x2=8.322, P=0.004). The hospital charges in the routine group and the presice group were (32713.7±8209.5) yuan and (27215.5±7871.3) yuan, respectively, with no significant difference between the two groups (t=4.421,P=0.801). The 1-year tumor recurrence rate was 42.7% in the routine group and 27.5% in the precise group, with a significant difference between the two groups (x2=5.781, P=0.016), and the 1-year survival rate was 82.9% in the routine group and 90% in the precise group, with no significant difference between the two groups (x2=0.938,P=0.333).Conclusion Compared with traditional hepatectomy, precise hepatectomy shows advantages in less trauma, postoperative recovery time and hospital stay, and it is safe and effective. |
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