Clinical Study Of Minor Liver Resection In The Treatment Of Bismuth-corlette Type Ⅱ And Ⅲ Hilar Cholangiocarcinoma

Purpose:To investigate the clinical effect and safety of minor liver resection in the treatment of Bismuth-Corlette Ⅱ and Ⅲ hilar cholangiocarcinoma.Method:A retrospective cohort study method was used.The clinicopathological data of82 patients with Bismuth-Corlette type Ⅱ and Ⅲ of hilar cholangiocarcinoma from June 2011 to June 2021 were collected.There were 52 males and 30 females,with an average age of 60.5 years.According to the willingness of the patients or their family members on the surgical method,they were divided into minor liver resection group(≤3 liver segments resection)(n=42)and major liver resection group(>3 liver segment resections)(n=40).Observation indicators: patient’s general condition,histopathological characteristics,operation time,intraoperative blood loss,hospital stay,postoperative liver function level,complication rate,serum tumor markers and other indicators.Categorical variables were compared using the chi-square test or Fisher’s exact test,and continuous variables were compared using the Student’s T test.P<0.05 was statistically significant.Result:Compared with the major liver resection group,the operative time(236.7 ±63.2min vs 310.3 ± 69.8min,P <0.001),the intraoperative blood loss(303.4 ±101.4m L vs 411.2 ± 219.7m L,P =0.005))and length of stay(14.5 ± 3.7d vs 17.4 ±4.6d,P =0.002)were significantly reduced in the minor liver resection group.Although there was no significant difference in the incidence of mild postoperative complications between the two groups,the incidence of severe postoperative complications(Dindo-Clavien Ⅲ-Ⅳ)in the minor liver resection group(6/42,14.3%vs 14/40,35.0%,P =0.029)was significantly lower than that in the major liver resection group,especially the incidence of postoperative liver failure(0/42,0.0% vs5/40,12.5%,P =0.024).In terms of laboratory examinations,the postoperative recovery time of liver function in the minor liver resection group was faster than that in the major liver resection group,among which,on the 7th day during the operation,the level of glutamate transaminase(ALT)(46.4 ± 28.1 U/L)vs 58.9 ± 25.3U/L,P=0.038),aspartate aminotransferase(AST)(36.7 ± 30.4U/L vs 52.6 ± 36.2U/L,P=0.034),albumin(36.5 ± 6.1g/L vs 32.3 ± 5.7g/L,P = 0.002).However,in terms of tumor markers at 3 months postoperatively,we found no significant difference in postoperative tumor recurrence rates between the two groups.Conclusion:For Bismuth-Corlette type II and III hilar cholangiocarcinoma,the curative effect of minor liver resection is definite,which can improve the safety of liver resection for hilar cholangiocarcinoma,and is of great significance in reducing the perioperative risk.