Comparison Of Extraglissonean And Intraglissonean Approch In Laparoscopic Right Hemihepatectomy Based On Laennec’s Capsule

Objective: To explore the safety and feasibility of extraglissonean and intraglissonean approach in laparoscopic right hemihepatectomy based on laennec’s capsule,and compare the clinical effect to provide a new method for laparoscopic right hemihepatectomy.Methods: The clinical data of 41 patients who underwent laparoscopic right hemihepatectomy in the Affiliated Hospital of Youjiang Medical University for Nationalities from March 2018 to September 2020 were analyzed retrospectively.19 patients underwent extraglissonean approach for Laparoscopic right hemihepatectomy based on laennec’s capsule(extraglissonean group)and 22 patients underwent intraglissonean right hemihepatectomy based on laennec’s capsule(intraglissonean group).Comparative analysis of the following data:(1)preoperative data: sex,age,Child-Pugh grade of liver function,with or without viral hepatitis,alanine transaminase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),prothrombin time(PT),albumin(ALB),American Association of Anesthesiologists(ASA)classification.(2)Perioperative data: operation time,intraoperative blood loss,intraoperative blood transfusion.(3)postoperative data: type of lesion,extraction time of abdominal drainage tube,postoperative complications(according to Clavien-Dindo classification),postoperative liver function related indexes(postoperative 1st,3rd,7th day),postoperative hospital stay.Results: Comparison of preoperative data: there was no significant difference between the two groups in sex,age,Child-Pugh grade of liver function,with or without viral hepatitis,ASA anesthetic risk grade,ALT,AST,TBIL,PT,ALB(P>0.05).Comparison of intraoperative data: laparoscopic right hemihepatectomy was successfully completed in both groups,and there was no death,no conversion or intraoperative blood transfusion.There was no significant difference in intraoperative blood loss(P>0.05).There was significant difference in operation time(P<0.05).Comparison of postoperative data: postoperative pathology showed that the cutting margins of the tumor was negative.there was no significant difference in pathological type,with or without liver cirrhosis,peritoneal drainage tube detaining time,related indexes of liver function,complications and postoperative hospitalization period between the two groups(P >0.05).Conclusion: Extraglissonean and intraglissonean approach for laparoscopic right hemihepatectomy based on laennec’s capsule is a safe and feasible procedure,and extraglissonean approach is more effective in terms of shorten operation time.