Five-staplers method with vascular closure device for right hemihepatectomy via anterior approach

doi:10.3877/cma.j.issn.2095-3232.2017.04.008

Abstract

Abstract:

Objective

To investigate the clinical application value of five-staplers method with vascular closure device for right hemihepatectomy via anterior approach.

Methods

Twenty-four patients with primary liver cancer who underwent right hemihepatectomy in the First People's Hospital of Foshan between January 2014 and June 2016 were enrolled in this prospective study. According to surgical methods, the patients were divided into the five-staplers method group (n=11) and control group (n=13). In the five-staplers method group, 11 cases were all males, aged (46±6) years old on average, and underwent right hemihepatectomy via anterior approach with five-staplers method. In the control group, 11 cases were males and 2 were females, aged (52±14) years old on average, and underwent right hemihepatectomy via anterior approach with traditional method. The informed consents of all patients were obtained and the local ethical committee approval was received. The general data, intraoperative and postoperative conditions were compared between two groups. The data such as the operation time and liver division time in two groups were compared using t test.

Results

Extra-Glissonean sheath dissection of the right hepatic pedicle for the hemi-hepatic flow occlusion was performed in the five-staplers group. While intra-Glissonean sheath dissection of the vessels and bile duct of the right liver lobe was performed in the control group, including 3 cases of Pringle maneuver. The operation time and liver division time in the five-staplers group was respectively (262±49) and (40±8) min, significantly shorter than (325±67) and (92±15) min in the control group (t=-2.255, -11.072; P<0.05). The intraoperative blood loss in the five-staplers group was (227±91) ml, significantly less than (892±275) ml in the control group (t=-8.193, P<0.05). No intraoperative blood loss ≥ 1 000 ml or intraoperative blood transfusion blood transfusion was observed in the five-staplers group, while 5 cases of intraoperative blood loss ≥ 1 000 ml and 4 of intraoperative blood transfusion were observed in the control group. No patient was switched to the ICU in the five-staplers group, while 4 cases were transferred to the ICU after surgery in the control group. The postoperative length of hospital stay in the five-staplers group and control group was respectively (11±2) and (10±2) d, and no significant difference was observed (t=0.488, P>0.05). No postoperative complications, such as rebleeding and bile leakage or surgery-related death was observed in two groups.

Conclusions

Five-staplers method with vascular closure device is a safe, simple, convenient and rapid method for right hemihepatectomy via anterior approach. Compared with the traditional method, it can shorter the operation time and liver division time, lower the intraoperative blood loss without increasing the postoperative length of hospital stay and incidence of postoperative complications.

Key words: Vascular closure device, Hepatectomy, Right hemihepatectomy via anterior approach, Five stapler, Liver neoplasms

Huanwei Chen, Feiwen Deng, Jianyuan Hu, Fengjie Wang, Jieyuan Li. Five-staplers method with vascular closure device for right hemihepatectomy via anterior approach[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 270-274.

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References 21

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组别	例数	男性（例）	年龄（岁，±s）	AST[U/L，M(Q_R)]	ALT[U/L，M(Q_R)]	ALP（U/L，±s）
五枪法组	11	11	46±6	40(29～393)	42(21～117)	097±33
对照组	13	11	52±14	35(17～85)0	28(10～61)0	101±35
统计值	?	-	t=-1.473	Z=1.363	Z=1.915	t=-0.551
P值	?	0.482	0.159	0.173	0.056	0.608
组别	例数	ALB（g/L，±s）	TB[μmol/L，M(Q_R)]	INR（比值，±s）	Scr（μmol/L，±s）
五枪法组	11	38±3	13(9～25)	1.03±0.16	85±15
对照组	13	40±4	16(8～71)	1.09±0.09	73±16
统计值	?	t=-1.140	Z=-0.696	t=-1.042	t=1.883
P值	?	0.266	0.487	0.309	0.159

组别	例数	男性（例）	年龄（岁，±s）	AST[U/L，M(Q_R)]	ALT[U/L，M(Q_R)]	ALP（U/L，±s）
五枪法组	11	11	46±6	40(29～393)	42(21～117)	097±33
对照组	13	11	52±14	35(17～85)0	28(10～61)0	101±35
统计值	?	-	t=-1.473	Z=1.363	Z=1.915	t=-0.551
P值	?	0.482	0.159	0.173	0.056	0.608
组别	例数	ALB（g/L，±s）	TB[μmol/L，M(Q_R)]	INR（比值，±s）	Scr（μmol/L，±s）
五枪法组	11	38±3	13(9～25)	1.03±0.16	85±15
对照组	13	40±4	16(8～71)	1.09±0.09	73±16
统计值	?	t=-1.140	Z=-0.696	t=-1.042	t=1.883
P值	?	0.266	0.487	0.309	0.159

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