| [Objective]Although the difficulty of laparoscopic hepatectomy is a highly subjective evaluation,there is an objective degree of difficulty in previous studies.At present,most experts think that laparoscopic hepatectomy involving liver segments Ⅰ,ⅣA,Ⅶand Ⅷ is a more difficult hepatectomy,but there is no more detailed classification of specific hepatectomy methods.The purpose of this study is to review the data of 144 cases of hepatectomy in our medical group,and to classify and compare the difficulty of hepatectomy.[Methods]The clinical data of 144 patients with complex liver segments(I,IVA,VII,VIII)under complete laparoscopy from May 2015 to may 2019 were analyzed retrospectively.It is divided into high difficulty group(≥ 5 points)and low difficulty group(≥ 4 points)on the basis of the difficulty score.To compare the difference of general data and perioperative data between the two groups,and to discuss the skill and experience of the medical group in the complicated subtotal hepatectomy.[Results]There were 45 cases in high difficulty group(HG)and 99 cases in low difficulty group(LG).No obvious difference was seen in general data between the two groups.There were 12 patients with right hemihepatectomy(12 vs 0,P=0.000),3 patients with extended right hemihepatectomy(3 vs 0,P=0.000),45 patients with right posterior lobectomy(11 cases in high score group,34 cases in low score group,no significant difference between the two groups(11 vs 0,P=0.000)34,P=0.160).The diameter of tumors in the right posterior lobe in the low group was significantly smaller than that in the high group(P=0.014);a total of 27 patients underwent segment VI or segment VII resection,all of them were in the low group(0 vs 27,P=0.000);11 patients underwent caudate lobectomy,7 in HG and 4 in LG.The patients in HG were more considerable than those in LG(7 vs 4,P=0.022);4 patients with left hemihepatectomy were all in low group(0 vs 4,P=0.000);there were 10 patients with central hepatectomy,8 patients with high-grade group,2 patients with low-grade group,and the patients with high-grade group were significantly more than those with low-grade group(8 vs 2,P=0.001);there were 10 patients with segment IV or segment VIII resection,all of them were in low-grade group(0 vs 10,P=0.02);the other patients in HG and LG(4 vs 14),p=0.115)do not differ in each other.The tumor diameter of the HG was evidently larger than that of the LG[(10.76± 3.27)cm vs(7.77± 2.25)cm,P=0.000],and the operation time was longer than that of the low group[(227.11±66.54)min vs(145.66 ± 4.64)min,P=0.000].As for the amount of bleeding,the high group was also significantly higher than the low group[(362.67±185.24)ml vs(140.91 ±68.20)ml,P=0.000].Four patients(8.89%)received blood transfusion in the high group,which had a higher proportion of blood transfusion(4/45 vs 1/99,P=0.033)compared with one patient(1.01%)in the low group,and the time of hepatic portal occlusion in the HG was also higher than that in the LG[(27.33± 4.84)min vs(20.30± 7.20)min,P=0.000],but there was no significant difference between the two groups(45/45 vs 97/99,P=0.088);in terms of postoperative complications,no obvious distinction was seen between the two groups(1/45 vs 0/99,P=0.313).There was also a significant difference between the two groups in postoperative hospital days[(8.87 ± 1.56)d vs(7.87 ± 1.20)d,P=0.000].As for ALT,AST and TBIL,no distinction was shown between HG and LG at different days before and after surgery,and the two groups gradually tended to normal values.[Conclusion]Laparoscopic hepatectomy has internal difficulty classification.Right hepatectomy,extended right hepatectomy,caudate lobectomy and central hepatectomy are more difficult.For right posterior lobectomy,the tumor with larger diameter is more difficult.Through good surgical field exposure and vascular management skills,complex hepatectomy can also be carried out safely and effectively. |
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