The Comparison Of Laparoscopic And Open Hemihepatectomy

Objective:To analyze and compare the safety and efficacy of laparoscopic hemihepatectomy and open hemihepatectomy in the treatment of liver diseases.Methods:The clinical data of all patients were collected from January 2012 to December 2017 in the Sir Run Run hospital in Zhejiang Province,and the patients were treated with concurrent hemihepatectomy.According to the collection data to exclude,exclude the standard:1,simultaneous bilateral hepatectomy,such as resection of left hepatectomy plus right half liver tumo removalr,2,combined with other organ surgery,such as left half liver resection plus gastric tumor resection,3,intraoperative intestinal anastomosis,4,incomplete information.we performed 1:1 propensity score matching between the two groups according to age,sex,liver cirrhosis,liver function Child-pugh grading,tumor size,invasion of portal vein,invasion of hepatic vein and preoperative tace treatment.To compare operation time,bleeding,intraoperative transfusion,postoperative complications and postoperative hospitalization time of the two groups.Results:In this study,138 groups of patients,including the left half of the liver resection 98 groups,right half liver resection 40 groups;The operative time(229.7±65.7)minutes of laparoscopic group was not significantly different from that in the open group(250.2±109.9)minutes(p=0.057),and intraoperative blood loss(364.3±389.7)ml in the laparoscopic group,It was significantly lower than that in the open group(531.4±610.4)(p=0.005),and the blood transfusion rate of laparoscopic group was 16.7%,which was lower than that of open group 47.9%(p=0.001).The hospitalization time of laparoscopic group(10.7±6.3)days was significantly lower than that of open group(13.1±8.8)days(p=0.009).There were 26 cases(18.8%)of postoperative complications in laparoscopic hemihepatectomy group,and there was no significant difference in 34 cases(24.6%)of open hemihepatectomy group(p=0.457).Convertiion occured in 17 cases,in 6 laparoscopic left hemihepatectomy,and in 11 laparoscopic right hemihepatectomy.There was no significant difference between intraoperative blood loss(938.2±667.0)ml of convertion group and the matched open group(691.2±705.8)ml(p=0.211).The operation time of convertion group was(330.9±181.3)minutes,significantly higher than the matched open group(235.0±39.3)minutes(p=0.037).The transfusion rate during convertion group was 53%,which was the same as that matched open group(53%)(P=1).The postoperative hospitalization time of lconvertion group was(15.5±8.2)days,and there was no significant difference(p=0.122)with the matched open group(11.6±5.8)days.Postoperative complications of convertion group occurred in 5 cases(29.41%),There was no significant difference with the open group in 2 cases(11.76%,p=0.398).No serious complications and death occurred in the two groups.Conclusions:Laparoscopic hemihepatectomy has been rapidly developed,and its operation time has been gradually shortened due to the development of laparoscopic instruments,the improvement of the surgeon's learning curve,and the accumulation of experience,and it is no longer significant difference compared with open hemihepatectomy.Laparoscopic hemihepatectomy is associated with less blood loss,lower of transfusion rate,shorter postoperative hospital stay with no comprmise in postoperatve complication.