Application Of LigaSure^TMSmall Jaw（LF1212A） For Parenchymal Division Of Hepatectomy Of Hepatic Carcinoma

Primary Hepatocellular acinoma is one of the most common malignant tumor.There are a number of methods of treatment for primary hepatic cancer, such assurgical resection, transcatheter arterial chemoembolization, radiofrequency ablation,radiotherapy, gene therapy, and so on. At present, hepatic transection is still thepreferred method of treatment in patients with hepatocellular carcinoma. Becausetraditionnal clamp crushing technique is low cost, simple, it is a widely acceptedmethod of hepatectomy. Under the situation of no special bleeding device, thistechnique is widely used during parenchymal division of hepatectomy of hepaticcarcinoma and does not reduce intraoperative blood loss and the needs for bloodtransfusion in liver cancer patients,which are the risk factors for increasedpostoperative morbidity and mortality.New techniques and instruments developed, even combined with low centralvenous pressure, have been utilized during the recent twenty years. Surgeon hope tominimize blood loss and blood transfusion during hepatectomy to reduce the rate ofpost-hepatectomy complications. These new instruments are CUSA, ultrasonicdissectors, bipolar coagulation, water jet dissection, stapling devices, LigaSure, andmonopolar floating ball, et al. In the field of hepatic resection in patients with cirrhosis,LigaSure combined with crush clamping could reduce bleeding, and combined use ofLigaSure and crush clamping technique was safe and could achieve rapidly completion of liver transection. Literature reported that bipolar coagulation have been used forlaparoscopic hepatectomy without hepatic inflow occlusion, and the use of bipolarcoagulation could reduce blood loss, transection time and didn’t increasehepatectomy-related complications. Patients could have a faster postoperative recovery.These methods and instruments are combined applition in liver surgery in order toreduce transaction time, intraoperative blood loss and close bile duct for the sake ofavoiding postoperative complications such as bleeding, bile leakage, et al.Hepatic transaction were carried out using a new instrument LF1212A or bipolarcoagulation by us. Now we compared the two common techniques used in hepatectomyin our hospital to summarize the advantages and disadvantages of LF1212A,retrospectively.Objective: The aim of this study was to evaluate the clinical efficacy of LF1212Aused during hapatectomy parenchymal transection of hepatic carcinoma.Methods: Between January2011and January2014,34consecutive cases of openhepatectomy of liver carcinoma were carried out using LF1212A or bipolar coagulationby the same surgen team. We collected and analyzed the operative and clinical outcomedata, retrospectively.Results: Among these patients, a total of17cases using LF1212A and17casesusing bipolar electrocautery were performed. The amount of blood loss were signifyca-antly reduced in the LF1212A group (76.47±59.42ml vs.127.06±80.47ml, p＝0.045),and the same as the operation time (110.04±13.15min vs.135.00±27.04min, p＝0.002)and the transaction time（47.12±9.99min vs.57.12±14.68min,p＝0.027.Compared withthe LF1212A group,the postoperative serum valus of the alanine aminotransferase(ALT),aspartate aminotransferase(AST) in bipolar coagulation group were significantlyincreased on the1th day (235.71±193.90umol/L vs.129.12±61.42umol/L; p＝0.044)and (243.29±181.88umol/L vs.129.12±61.42umol/L; p＝0.020). The changes in serumenzyme levels (ALT, AST) were transient with tendency to return to normal level within7days in all patient.There were no wound infection, postoperative bleeding, bile leakage and live failure,even mortality of the two groups. The drainage flow of postoperative three daysand post-hepatectomy complication were not significantly difference between the twogroups(p>0.05).Conclusion: The hepatic resection of patients with liver cancer were carried outby using LF1212A or bipolar coagulation without inflow vascular occlsion.Comparionof the two techniques, the results of this study suggest:(1) There are no serious complications, and the postoperative morbidity are similar inhepatectomy of the two groups. They both are equally safe for hepatic resection.(2) With the LF1212A, the hepatic tissue has less damage to the liver, less impact onliver function. And no eschar appears on the cut surface, the surgical field is clear tomake identification of bile leakage or persistent bleeding easy to detect and suture.(3) The liver division with LF1212A can effectively reduce intraoperative blood loss,the possibility of blood transfusion, transection time, operation time,but also reducethe duration of anesthesia. Thereby these factors reduce the damage of liver function,which Contribute to rapid postoperative recovery.