A Comparative Study Of Hepatectomy For Primary Liver Cancer With Or Without Hepatic Blood Inflow Occlusion

Objective: To compare the impact of hepatectomy for primary hepatic carcinoma with or without hepatic blood inflow exclusion during perioperative period.Methods: We performed a retrospective analysis on 45 patients with primary liver cancer who underwent hepatectomy in the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Chongqing Medical University between January,2015 and January,2018,including 19 patients of intermittent Pringle maneuver(group A),10 patients of hemihepatic vascular exclusion(group B),and 16 patients without hepatic blood inflow exclusion(group C).The blood loss,operation time,and the levels of postoperative liver function [albumin(Alb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(Tbil),prothrombin time(PT)] were compared among the three groups.Results: Compared with group C,the intraoperative blood loss in group B was significantly increased:(795.0±463.4)mL vs(343.8±361.3)mL,while operation time in group A and B were significantly prolonged:(230.5±52.7)min vs(241.5±64.1)min vs(190.6±52.6)min,with statistically significant differences(P<0.05).One day after surgery,the levels of Alb in group A and B were lower than those of group C:(33.8±3.7)g/L vs(32.6±4.1)g/L vs(36.8±3.1)g/L,while the levels of Tbil,AST in group A and B were significantly higher than those of group C: Tbil(28.1±10.2)μmol/L vs(28.6±12.8)μmol/L vs(17.2±6.7)μmol/L,AST(454.1±256.7)U/L vs(421.4±265.3)U/L vs(229.5±152.1)U/L,with statistically significant differences(P<0.05).Three days after surgery,the levels of Tbil,ALT,AST,PT in group A were higher than group C: Tbil(28.3±13.8)μmol/L vs(19.7±8.2)μmol/L,ALT(278.7±198.8)U/L vs(145.0±98.6)U/L,AST(196.7±135.2)U/L vs(89.2±83.2)U/L,PT(15.9±1.4)s vs(14.6±1.1)s,while the level of Alb in group B was lower than that of group C:(31.5±3.5)g/L vs(34.7±3.1)g/L,all with statistically significant differences(P<0.05).Seven days after surgery,the levels of AST,PT in group A were higher than those in group C: AST(57.7±16.4)U/L vs(39.6±15.8)U/L,PT(14.9±0.9)s vs(14.2±0.6)s,and the levels of Alb in group B were lower than that in group C:(29.6±10.4)g/L vs(35.5±3.5)g/L,all with statistically significant difference(P<0.05).The postoperative hospitalization time of group A was significantly longer than that of group C:(14.9±0.9)d vs(12.2±2.8)d,P<0.05.Conclusion: Compared with groups with blood inflow occlusion,hepatectomy for hepatic carcinoma without hepatic blood inflow occlusion is also safe and feasible under appropriate indications,which can significantly shorten the operation time,reduce intraoperative blood loss and improve the recovery of postoperative liver function damage.