| Objective:This study intends to investigate the value of the short hepatic portal vein first in radical surgery for hepatoportal cholangiocarcinoma.Methods:Patients with hilar cholangiocarcinoma cholangiocarcinoma who met the inclusion as well as exclusion criteria admitted to the Department of Hepatobiliary and Pancreatic Surgery,Henan University People’s Hospital from 01/01/2020 to 12/31/2022 were retrospectively analyzed to compare the data related to the short hepatic portal vein first group with the conventional surgical approach group.Results:There were 14 cases in the short hepatic portal vein first group and 41 cases in the conventional surgical approach group.8 males and 6 females in the short portal vein first group and 26 males and 15 females in the conventional surgical approach group,consistent between the two groups(χ2=0.174,p=0.667);the mean age of the short hepatic portal vein group was 67.29±8.43 years consistent with the mean age of the conventional surgical approach group of 63.93±6.61 years(t=1.528,p=0.132);4 cases(28.57%)of preoperative combined hypertension in the short hepatic portal vein first group and 11 cases(26.83%)in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.000,p=1.000);4 cases(28.57%)of preoperative combined diabetes in the short hepatic portal vein first group and 7 cases(17.07%)of preoperative combined diabetes in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.293,p=0.588);history of previous abdominal surgery in 4 cases(28.57%)in the short hepatic portal vein first group and 6 cases(14.63%)in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.587,p=0.444);4 open and 10 laparoscopic cases in the short hepatic portal vein first group and 13 open and 28 laparoscopic cases in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.000,p=1.000);Bismuth-Corlett staging and preoperative liver function(albumin,ALT,AST,alkaline phosphatase,glutamyl transpeptidase,total bilirubin,direct bilirubin,indirect bilirubin)were consistent in both groups(p>0.05).The intraoperative bleeding volume in the short hepatic portal vein first group was 250(200,450)ml less than that in the conventional surgical approach group,which was 500(300,500)ml(z=-2.120,p=0.034);the intraoperative blood transfusion volume in the short hepatic portal vein first group was 0(0,1250)ml consistent with that in the conventional surgical approach group,which was 0(0,1250)ml(z=-0.138,p=0.891);the operative time in the short hepatic portal vein first group was 489.64±104.60 min longer than that in the conventional surgical approach group 396.15±109.45 min(t=2.790,p=0.007).The number of postoperative hospital days 17.50(11.00,23.75)d in the short hepatic portal vein first group was consistent with 18.00(14.00,23.50)d in the conventional surgical approach group(z=0.416,p=0.677);liver function was consistent between the two groups on postoperative days 1,3 and 7(p>0.05);postoperative bleeding occurred in one case in the short hepatic portal vein first group and in four cases in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.000,p=1.000);1 postoperative pulmonary infection in the short hepatic portal vein first group and 12 postoperative pulmonary infections in the conventional surgical approach group,with no statistical difference between the two groups(χ2=1.737,p=0.187);1 postoperative incisional infection in the short hepatic portal vein first group and 6 postoperative incisional infections in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.069,p=0.794);5 postoperative incisional infections in the short hepatic portal vein first group and 17 in the conventional surgical approach group,with no statistical difference between the two groups(χ2=0.144,p=0.705);there were no perioperative postoperative deaths in the short hepatic portal vein first group and 3 perioperative postoperative deaths in the conventional surgical approach group(χ2=0.129,p=0.719),with no statistical difference between the two groups;postoperative complications were graded as grade Ⅰ in 8 cases,grade Ⅱ in 3 cases,grade Ⅲb in 3 cases,no grade Ⅲa,gradeⅢb,grade Ⅳa,grade Ⅳb,grade V in the short hepatic portal vein first group and grade Ⅰ in 21 cases,gradeⅡ in 8 cases,grade Ⅲa in 6 cases,grade Ⅲb in 1 case,grade Ⅳa in 2 cases,grade Ⅴ in 3 cases,grade Ⅴ in 3 cases,no grade IVb,and 3 cases were grade Ⅴ,and there was no statistical difference between the two groups(χ2=9.019,p=0.108);the 1-and 2-year survival rates were 67.5%and 46.3%for the short hepatic portal vein first group and 69.0%and 55.9%for the conventional surgical approach group,respectively,with no statistically significant difference in overall survival between the two groups(χ2=0.608,p=0.436).Conclusion:Radical surgery for hilar cholangiocarcinoma with short hepatic portal vein first can reduce intraoperative bleeding and will not increase the occurrence of postoperative complications,prolong patients’postoperative hospital stay,nor affect patients’ survival prognosis,and may even reduce the occurrence of postoperative complications with high safety. |
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