Comparative study on the efficacy of anatomic segmentectomy and non-anatomic segmentectomy with the third hepatic pedicle in patients with hepatocellular carcinoma

doi:10.3877/cma.j.issn.1674-3946.2022.06.010

Abstract

Abstract:

Objective

To investigate the effect of anatomic hepatectomy（AR）and non-anatomic hepatectomy（NAR）led by the third liver pedicle on the prognosis of liver cancer patients.

Methods

The clinical data of 89 patients with primary liver cancer who underwent hepatectomy from July 2015 to December 2017 were retrospectively analyzed. According to different surgical methods，they were divided into AR group（n=45）and NAR group（n=44）. The data were processed by SPSS 22.0 software. The perioperative indicators and liver zymogram changes of the two groups were expressed as（

x ˉ

±s），and independent t test was used. χ² or Fisher exact test was used for postoperative complications and positive rate of surgical margin. The postoperative recurrence rate was analyzed by Log-Rank test. P<0.05 was statistically significant.

Results

The blood loss and positive rate of surgical margin in AR group were significantly lower than those in NAR group（blood loss：414 ml vs. 973 ml，P<0.01；The positive rate of surgical margin was 0% vs. 10%，P=0.056），and the recurrence rate at 6 and 12 months after surgery was significantly lower than that in the NAR group（6.7% vs. 20.5%，P=0.058；15.6% vs. 40.9%，P=0.008）；The operation time in AR group was significantly longer than that in NAR group（325 min vs. 270 min，P=0.041）. The liver function of AR group was less affected after operation（P<0.01），and the comparison between the two groups was statistically significant. There was no significant difference in the incidence of postoperative serious complications between the two groups（P>0.05）.

Conclusion

Compared with non-anatomical hepatectomy，anatomical hepatectomy led by the third hepatic pedicle is a more appropriate surgical method for the treatment of liver cancer，with less intraoperative blood loss，less postoperative liver function impact，and lower postoperative recurrence rate.

Key words: Liver neoplasms, Anatomic liver resection, Nonatomic liver resection, Recurrence

Bin Hu, Wei Zhao, Hongbo Huan, Ziman Zhu, Mingming Han, Yuliang Tu, Dadong Wang, Shouwang Cai. Comparative study on the efficacy of anatomic segmentectomy and non-anatomic segmentectomy with the third hepatic pedicle in patients with hepatocellular carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(06): 618-621.

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References 17

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组别	例	性别 (男/女)	年龄 (岁)		总胆红素(umol/L)		白蛋白(g/L)
NAR	44	27/17	61.9±9.4		17.0±12.5		44.7±4.2
AR	45	33/12	62.1±10.3		16.0±10.0		45.7±4.2
χ²/t		1.451	-0.097		0.41		-1.12
P		0.228	0.451		0.736		0.745
组别	例	凝血酶原时间(s)	胆碱脂酶(KU/L)		谷氨酰转肽酶(U/L)		碱性磷酸酶(U/L)
NAR	44	12.6±1.7	5.9±1.7		43.0±47.5		87.0±38.5
AR	45	13.3±1.7	6.7±1.6		47.0±57.1		82.0±38.7
χ²/t		-1.964	-2.268		-0.355		0.608
P		0.671	0.73		0.753		0.846
组别	例	谷草转氨酶(U/L)		谷丙转氨酶(U/L)		Child-Pugh classA/B
NAR	44	60.8±36.7		62.9±28.1		36/8
AR	45	47.3±31.5		47.8±30.0		40/5
χ²/t		1.867		2.454		0.892
P		0.863		0.972		0.345

组别	例	性别 (男/女)	年龄 (岁)		总胆红素(umol/L)		白蛋白(g/L)
NAR	44	27/17	61.9±9.4		17.0±12.5		44.7±4.2
AR	45	33/12	62.1±10.3		16.0±10.0		45.7±4.2
χ²/t		1.451	-0.097		0.41		-1.12
P		0.228	0.451		0.736		0.745
组别	例	凝血酶原时间(s)	胆碱脂酶(KU/L)		谷氨酰转肽酶(U/L)		碱性磷酸酶(U/L)
NAR	44	12.6±1.7	5.9±1.7		43.0±47.5		87.0±38.5
AR	45	13.3±1.7	6.7±1.6		47.0±57.1		82.0±38.7
χ²/t		-1.964	-2.268		-0.355		0.608
P		0.671	0.73		0.753		0.846
组别	例	谷草转氨酶(U/L)		谷丙转氨酶(U/L)		Child-Pugh classA/B
NAR	44	60.8±36.7		62.9±28.1		36/8
AR	45	47.3±31.5		47.8±30.0		40/5
χ²/t		1.867		2.454		0.892
P		0.863		0.972		0.345

组别	例	手术时间 (min)	术中出血量 (ml)	术中肝蒂阻断时间(min)	住院时间 (d)
NAR	44	270.0±130.0	973.0±577.0	26.0±13.0	22.0±12.5
AR	45	325.0±120.0	414.0±168.0	56.0±26.0	18.8±12.2
χ²(Fisher)/t		2.075	6.235	6.86	1.222
P		0.041	<0.01	<0.01	0.225

组别	例	手术时间 (min)	术中出血量 (ml)	术中肝蒂阻断时间(min)	住院时间 (d)
NAR	44	270.0±130.0	973.0±577.0	26.0±13.0	22.0±12.5
AR	45	325.0±120.0	414.0±168.0	56.0±26.0	18.8±12.2
χ²(Fisher)/t		2.075	6.235	6.86	1.222
P		0.041	<0.01	<0.01	0.225

组别	例	肺部感染	腹腔出血	胸腔积液	腹水	胆瘘	肾功能不全	手术死亡
NAR	44	11	2	31	32	7	1	0
AR	45	5	1	33	21	6	0	0
χ²(Fisher)/t		2.910	-	0.091	6.273	0.118	-	-
P		0.088	0.616	0.763	0.012	0.731	0.494	-

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