Clinical Application Studying Of Laparoscopic Hemihepatectomy

Objective:To study the feasibility and safety of laparoscopic hemihepatectomy,to explore the control of blood flow,the disconnection of liver parenchyma,the prevention and treatment of hepatic venous hemorrhage,the prevention and treatment of complications.Methods: The clinical data of 40 patients undergoing laparoscopic hemihepatectomy during the period from January 2017 to December 2018 in our hospital hepatobiliary surgery were collected,retrospective study,the clinical data of 40 patients with open hemihepatectomy were selected as the control group.Comparison of preoperative clinical indicators between the two groups of patients,the differences of postoperative indexes between the two groups were compared: operation time,intraoperative blood loss,blood transfusion ratio,recovery time of gastrointestinal function,postoperative physiological indexes(liver function,blood routine,hemagglutination index),analgesic use time,postoperative complications,postoperative hospital stay,calculi clearance rate.Results:The study included a total of 80 patients,including 25 cases of laparoscopic left hemihepatectomy and 15 cases of laparoscopic right hemihepatectomy,In the open group,16 patients underwent right hemihepatectomy and 24 patients underwent left hemihepatectomy.The operation time of the laparoscopic group was(279.6±69.1)minutes,compared with the operation time of the open group(254.4±82.2)minutes,there was no significant difference(P=0.247);Intraoperative hemorrhage(430.8± 103.7)milliliters in the laparoscopic hemihepatectomy group was significantly lower than that in the open hemihepatectomy group(613.2 ± 248.9)milliliters(P = 0.001);The blood transfusion rate in the laparoscopic hemihepatectomy group was 30%,which was lower than that in the open hemihepatectomy group(52.5%)(P=0.041).The analgesic(2.7±0.8)days were used in the laparoscopic hemihepatectomy group,which was less than the open hemihepatectomy group(4.4±0.9)days(P<0.05).The recovery time of gastrointestinal function in the laparoscopic hemihepatectomy group(3.0±0.5)days was lower than that in the open hemihepatectomy group(4.3±0.7)days(P<0.05).The postoperative hospital stay was(9.0±2.7)days in the laparoscopic hemihepatectomy group and significantly shorter than the open hemihepatectomy group(13.9±8.8)days(P=0.01).The calculi clearance rate was 90.6% in the laparoscopic group and 90%(P=1.0)in the open group.There was no significant difference.There were 8 patients(20%)with postoperative complications in the laparoscopic hemihepatectomy group and 10 patients(25%)with open hemihepatectomy,There was no significant difference between the two groups(P=0.592).There were no significant differences in the changes of liver function,blood routine,and hemagglutination between the laparoscopic hemihepatectomy group and the open hemihepatectomy.There were no serious complications such as liver failure and death in the laparoscopic hemihepatectomy group and the open hemihepatectomy group.Conclusion: Laparoscopic hemihepatectomy compared with open hemihepatectomy has the advantages of low intraoperative blood loss,low blood transfusion rate,less use of analgesics,rapid recovery of postoperative gastrointestinal function,and short hospital stay.There was no significant difference in the operation time,the effect on postoperative liver function,and the incidence of postoperative complications,the calculi clearance rate.Strictly grasp the surgical indications,based on the clinical experience of excellent open liver resection,with a tacit surgical team,skilled laparoscopic operation techniques,effective blood flow control,meticulous hepatic parenchymal disconnection,and reasonable prevention of hepatic venous hemorrhage and treatment measures are necessary for successful surgery,laparoscopic hemihepatectomy is a safe and feasible surgical method.