Application value of precise hepatectomy in huge hepatocellular carcinoma
10.3877/cma.j.issn.2095-3232.2015.01.005
- VernacularTitle:精准肝切除在巨大肝细胞癌中的应用价值
- Author:
Xun LI
1
;
Di TANG
;
Baogang PENG
;
Chunlin JIANG
;
Ming KUANG
;
Lijian LIANG
Author Information
1. 中山大学附属第一医院肝胆外科
- Keywords:
Carcinoma,hepatocellular;
Hepatectomy;
Hepatic insufifciency
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2015;(1):17-20
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the application value of precise hepatectomy in huge hepatocellular carcinoma (HCC). Methods The objects of this prospective study were 110 patients with huge HCC undergoing precise hepatectomy in the First Afifliated Hospital of Sun Yat-sen University from May 2009 to May 2013. There were 92 males and 18 females with the age ranging from 26 to 75 years old and a median age of 48 years old. The range of tumor diameter was 10-21 cm. The informed consents of all patients were obtained and local ethical committee approval had been received. All patients underwent thin-slice computer tomography (CT) scan. The livers, tumors and vessels were three-dimensionally reconstructed using Myrian XP Liver surgery simulation software with the original data of thin-slice CT scan. The standard remnant liver volume (SRLV) was calculated, and the simulated operation was performed. Hepatectomy after conventional dissecting of the liver or hepatectomy with presetting hanging band in front of inferior vena cava through anterior approach were performed. The accordance rate of preoperative simulated operation plan and the actual performed intraoperative operation plan was observed. The difference between the predicted SRLV before operation and the actual measured SRLV was compared. The operative time, intraoperative blood loss, blood transfusion, length of hospital stay and complications were observed. The comparison of predicted SRLV and the actual measured SRLV was conducted using t test. Results The accordance rate of preoperative simulated operation plan and the actual intraoperative operation plan was 92.7%(102/110). The predicted SRLV before operation was (392±96) ml/m2, and the intraoperative actual measured SRLV was (406±71) ml/m2, where no significant difference was observed (t=-1.230, P>0.05). The median of operative time was 200 (150-375) min. The intraoperative blood loss was 500 (150-2 000) ml. The intraoperative blood transfusion was 300 (0-1 500) ml. The length of postoperative hospital stay was 11 (8-67) d. No perioperative death was observed. The incidence of postoperative complications was 20.0%(22/110). Eighteen cases suffered hepatic dysfunction and were cured by symptomatic treatments such as liver protection. Three cases suffered biliary leakage and were relieved by persistent catheter drainage. One case suffered abdominal bleeding and underwent the second surgery to stop bleeding. Conclusions Precise hepatectomy can help to better resect huge HCC, retain more residual liver volume, and reduce the incidence of postoperative hepatic dysfunction. It is an effective and safe method of treating huge HCC.
