To evaluate the application of precise liver dissection technique in complex hepatectomy.

Sixty cases of complex hepatectomy from Feburary 2003 to June 2009 were analyzed retrospectively, which included 13 cases of donor right hepatic lobes harvested in living donor liver transplantation (LDLT), 37 cases of liver malignant tumor and 10 cases of hepatic giant cavernous hemangioma. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. Helix hydro-jet and cavitron ultrasonic surgical aspirator (CUSA) were applied with the assistance of precise radiographic techninque before and/or during the operation. Among these patients, right hepatic resection was performed in 13 cases, right hepatic trisegmentectomy in 8 cases, hepatic segment Ⅵ+Ⅶ resection in 19 cases, segment Ⅳ+Ⅴ+Ⅷ resection in 9 cases, segment Ⅷ resection in 5 cases and caudate lobe resection in 6 cases. The intraoperative blood loss, operation time, postoperative hepatic function such as alanine aminotransferase(ALT), aspartate aminotransferase(AST), albumin(ALB), prothrombin time(PT), total bilirubin(TB), direct bilirubin(DB) and complications in these patients were recorded.

The average operation time was 370 min and average intraoperative blood loss was 955 ml. Thirteen out of 60 patients (22%) received heterologous packed red blood cell (PRBC) transfusion for more than 2 units per case. ALT, AST and DB recovered normal in 7 days after operation and ALB, TB recovered normal in 5 days after operation. The average length of stay in hospital was 11.7 days. Post-operative complications included ascites in 6 cases, hydrothorax in 5 cases, atelectasis in 2 cases and pulmonary infection in 4 cases. No severe complications and death occurred in this group.

Precise liver dissection is useful in complex hepatectomy. There is not massive blood loss during operation nor sereve complications after operation and the liver funtion recovery is good.