Clinical Application And Efficacy Of Right Hemihepatectomy Under Precise Right Hemipelvectomy With Total Blood Flow Block

Objective: To analyze the clinical application and efficacy of right hemihepatectomy under precise right hemipelvectomy with total blood flow block,and to clarify the feasibility and efficacy of right hepatic lobectomy with precise right hepatic total flow block.Methods: A retrospective study method was used to collect a total of 47 patients who underwent right hepatic lobectomy for right hemi-hepatic occupying lesions in our hospital(Affiliated Hospital of Youjiang Medical University for Nationalities)from 2017-2021 as study subjects.The general clinical data of the patients were collected including gender,age,Child-Pugh classification,AFP,presence of cirrhosis,presence of viral hepatitis B,preoperative liver function [including glutamic aminotransferase(ALT),glutamic aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBILI),albumin(ALB).The collected case data were divided into(1)observation group(N1): the right lobe of liver resection group under precise right hemi-hepatic total blood flow blockage,totaling 29 cases;(2)control group(N2): the right lobe of liver resection group under Pringle method blood flow blockage,totaling 18 cases.In the control group,the Pringle method was used to intermittently block blood flow to the hepatoduodenal ligament,with each flow block lasting15 min and a resumption time of 5 min.The hepatic blood flow in the right hepatic lobectomy group is blocked by:(1)lowering the hepatic portal,dissecting the first hepatic portal and ligating the right hepatic artery.The right branch of the portal vein is dissected and ligated at its root;(2)the second hepatic hilar is dissected and ligated before the right hepatic vein joins the inferior vena cava;(3)the third hepatic hilar is dissected and ligated before the short hepatic vein in the right posterior lobe joins the inferior vena cava behind the liver.This completes the blockage of all blood flow to the right lobe of the liver.Intraoperative operating time,bleeding,blood transfusion and tumour size were recorded for both groups;postoperative complications were recorded for both groups,liver function was tested on postoperative days 1,3,5 and 7,and the recurrence rate and 1-year survival rate of hepatocellular carcinoma were followed up 1 year after surgery.Results: Comparing the general clinical data of the two groups including patients’ gender,age,Child-Pugh classification,preoperative AFP,presence of cirrhosis,presence of viral hepatitis B,preoperative liver function [including glutamic aminotransferase(ALT),Aspartate Aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBILI),and albumin(ALB)],the results were not significantly different statistically significant(P > 0.05).Comparison of postoperative liver function,total bilirubin and direct bilirubin levels on postoperative days 1,3,5 and 7 between the two groups showed no statistically significant differences(P>0.05);The albumin level in the N1 group was higher than that in the N2 group on postoperative days 5 and 7,with a statistically significant difference(P<0.05);Glutathione levels were lower in the N1 group than in the N2 group on postoperative days 1,3,5 and 7,and the difference was statistically significant(P<0.05);On postoperative days 1,3,5 and 7,glutamic oxalacetic transaminase was lower in the N1 group than in the N2 group,and the difference was statistically significant(P<0.05).The median operative time was 3.1h for the N1 group and 3.0h for the N2 group,with no statistically significant difference in any of the results(P>0.05).The median surgical bleeding was 450 ml in the N1 group and 575 ml in the N2 group,with the N1 group being lower than the N2 group and the difference being statistically significant(P<0.05);The difference in intraoperative blood transfusion and tumour size between the two groups was not statistically significant(P>0.05);there were no surgical deaths in either group.Comparing the two groups of postoperative complications,there were 9(31%)and 5(27.8%)cases(rate)of pulmonary infection in the N1 and N2 groups,respectively,with no statistically significant difference(P>0.05);and 6(20.7%)and2(11.1%)cases(rate)of pleural effusion,respectively,with no statistically significant difference(P>0.05).No postoperative abdominal haemorrhage,biliary fistula,liver failure or death occurred in either group.The recurrence rate of liver cancer at 1 year after follow-up was 4(13.8%)cases(rate)and 3(16.7%)cases(rate)in the N1 and N2 groups,respectively,with no statistically significant difference(P>0.05);the survival rate at 1 year after surgery was 25(86.2%)cases(rate)and 15(83.3%)cases(rate)in the N1 and N2 groups,respectively,with no statistically significant difference(P>0.05).Conclusion: Precision right hemihepatectomy with total right hepatic flow blocking technique can effectively reduce surgical bleeding,accelerate post-operative liver function recovery,and provide satisfactory post-operative complication control and good prognosis.Therefore,the precise right hemipelvectomy technique is feasible and effective.