Application of round ligament fissure approach in re-hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Qing ,  GAO Fengwei , LIU Yu , XUE Qian , FU Jinqiang

Department of Hepatopancreatobiliary Surgery, Leshan People’s Hospital, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

GAO Fengwei, Email: 707850255@qq.com

Keywords：

recurrent hepatocellular carcinoma; round ligament fissure approach; re-hepatectomy; liver function; intraoperative bleeding

DOI：

10.7507/1007-9424.202012067

Video：

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Objective To investigate the effect of the round ligament fissure approach in re-hepatectomy.Methods A total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.Results Compared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).Conclusion Re-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.

Citation： WANG Qing, GAO Fengwei, LIU Yu, XUE Qian, FU Jinqiang. Application of round ligament fissure approach in re-hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 155-159. doi: 10.7507/1007-9424.202012067 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	龔奇, 徐鋒, 趙亮, 等. ALPPS 術后肝再生與內質網應激 IRE1α-XBP1 通路的關系研究. 中國普外基礎與臨床雜志, 2019, 26(10): 1162-1169.
3.	胡澤明, 陳彪, 鐘佳寧, 等. 原發性肝癌治療方法的應用進展. 山東醫藥, 2019, 59(9): 106-110.
4.	張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
5.	肖朝輝, 劉榮. 肝癌患者術后復發分子標志物的臨床研究進展. 中華肝膽外科雜志, 2017, 23(4): 277-281.
6.	鄧小斌. 肝癌肝切除術后復發再手術治療價值及術式選擇. 臨床外科雜志, 2017, 25(6): 429-430.
7.	劉袁君, 吳泓, 曾勇, 等. 腔鏡超聲聯合熒光顯像在腹腔鏡肝切除術中的應用. 中國普外基礎與臨床雜志, 2020, 27(6): 662-665.
8.	孫科, 肖宏, 陳安平, 等. 肝圓韌帶入路在腹腔鏡再次膽道取石術中的應用價值. 中華消化外科雜志, 2019, 18(2): 160-164.
9.	Isetani M, Morise Z, Kawabe N, et al. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol, 2015, 21(3): 961-968.
10.	中華醫學會外科學分會肝臟學組. 腹腔鏡肝切除術專家共識 (2013 版). 中國腫瘤臨床, 2013, 40(6): 303-306.
11.	朱武剛, 陸曉蘭, 劉洪濤, 等. 肝癌根治術后輔助 TACE 療效的 meta 分析. 介入放射學雜志, 2019, 28(9): 865-869.
12.	何生, 鄧靖宇, 羅書畫. 復發性肝癌再手術的療效. 臨床外科雜志, 2005, 13(3): 135-136.
13.	陳克霏, 唐友銀, 賈貴清, 等. 復雜泡型肝包蟲根治性肝切除的 MDT 討論. 中國普外基礎與臨床雜志, 2018, 25(1): 77-82.
14.	Takagi C, Itano O, Yagi H, et al. Laparoscopic liver resection for patients with a history of upper abdominal surgery. HPB, 2016, 18: e313.
15.	楊明坤. 肝圓韌帶入路的解剖性肝切除術. 西南國防醫藥, 2014, 24(9): 964-966.
16.	柴乃俊, 蔣澤斌, 趙慧琪, 等. 保留尾狀葉肝次全切除治療肝內膽管結石病. 中國普外基礎與臨床雜志, 2018, 25(2): 207-212.
17.	曹君, 陳亞進. 淺談腹腔鏡肝切除之入路. 中華外科雜志, 2019, 57(7): 503-507.
18.	Ibukuro K, Takeguchi T, Fukuda H, et al. Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver. Surg Radiol Anat, 2016, 38(9): 1061-1067.
19.	譚文勇, 羅強, 何平. 不同入路下行左肝外葉切除術對機體創傷應激反應程度及殘余肝功能影響. 標記免疫分析與臨床, 2018, 25(1): 44-49.
20.	申東方, 顧小暉, 漆道金, 等. 大鼠肝部分切除術后肝細胞生長因子、轉化生長因子-β1 水平變化及脾動脈結扎對大鼠肝再生的影響. 中華實驗外科雜志, 2019, 36(3): 455-457.
21.	方兆山, 楊劍, 龐玨, 等. 3D 腹腔鏡 Glisson 蒂橫斷式肝切除術治療肝癌對機體細胞免疫功能的影響. 實用醫學雜志, 2018, 34(12): 2004-2006, 2011.
22.	陳熙, 胡朝輝, 彭永海, 等. 控制性低中心靜脈壓在腹腔鏡肝切除中的應用: 前瞻性隨機對照研究. 中國微創外科雜志, 2018, 18(7): 585-589.
23.	張勝龍, 楊先偉, 王文濤. 泡型肝包蟲病肝切除術后膽漏發生危險因素分析. 中華普通外科雜志, 2020, 35(1): 26-29.
24.	徐亞男, 姜洪池. 肝門部膽管癌肝切除術后肝功能衰竭的危險因素及治療策略. 中華普通外科雜志, 2018, 33(12): 1076-1078.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 龔奇, 徐鋒, 趙亮, 等. ALPPS 術后肝再生與內質網應激 IRE1α-XBP1 通路的關系研究. 中國普外基礎與臨床雜志, 2019, 26(10): 1162-1169.
3. 胡澤明, 陳彪, 鐘佳寧, 等. 原發性肝癌治療方法的應用進展. 山東醫藥, 2019, 59(9): 106-110.
4. 張宇, 楊沖, 王燚, 等. 離體肝切除和自體肝移植聯合復雜肝靜脈重建治療終末期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2018, 25(10): 1236-1241.
5. 肖朝輝, 劉榮. 肝癌患者術后復發分子標志物的臨床研究進展. 中華肝膽外科雜志, 2017, 23(4): 277-281.
6. 鄧小斌. 肝癌肝切除術后復發再手術治療價值及術式選擇. 臨床外科雜志, 2017, 25(6): 429-430.
7. 劉袁君, 吳泓, 曾勇, 等. 腔鏡超聲聯合熒光顯像在腹腔鏡肝切除術中的應用. 中國普外基礎與臨床雜志, 2020, 27(6): 662-665.
8. 孫科, 肖宏, 陳安平, 等. 肝圓韌帶入路在腹腔鏡再次膽道取石術中的應用價值. 中華消化外科雜志, 2019, 18(2): 160-164.
9. Isetani M, Morise Z, Kawabe N, et al. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol, 2015, 21(3): 961-968.
10. 中華醫學會外科學分會肝臟學組. 腹腔鏡肝切除術專家共識 (2013 版). 中國腫瘤臨床, 2013, 40(6): 303-306.
11. 朱武剛, 陸曉蘭, 劉洪濤, 等. 肝癌根治術后輔助 TACE 療效的 meta 分析. 介入放射學雜志, 2019, 28(9): 865-869.
12. 何生, 鄧靖宇, 羅書畫. 復發性肝癌再手術的療效. 臨床外科雜志, 2005, 13(3): 135-136.
13. 陳克霏, 唐友銀, 賈貴清, 等. 復雜泡型肝包蟲根治性肝切除的 MDT 討論. 中國普外基礎與臨床雜志, 2018, 25(1): 77-82.
14. Takagi C, Itano O, Yagi H, et al. Laparoscopic liver resection for patients with a history of upper abdominal surgery. HPB, 2016, 18: e313.
15. 楊明坤. 肝圓韌帶入路的解剖性肝切除術. 西南國防醫藥, 2014, 24(9): 964-966.
16. 柴乃俊, 蔣澤斌, 趙慧琪, 等. 保留尾狀葉肝次全切除治療肝內膽管結石病. 中國普外基礎與臨床雜志, 2018, 25(2): 207-212.
17. 曹君, 陳亞進. 淺談腹腔鏡肝切除之入路. 中華外科雜志, 2019, 57(7): 503-507.
18. Ibukuro K, Takeguchi T, Fukuda H, et al. Spatial anatomy of the round ligament, gallbladder, and intrahepatic vessels in patients with right-sided round ligament of the liver. Surg Radiol Anat, 2016, 38(9): 1061-1067.
19. 譚文勇, 羅強, 何平. 不同入路下行左肝外葉切除術對機體創傷應激反應程度及殘余肝功能影響. 標記免疫分析與臨床, 2018, 25(1): 44-49.
20. 申東方, 顧小暉, 漆道金, 等. 大鼠肝部分切除術后肝細胞生長因子、轉化生長因子-β1 水平變化及脾動脈結扎對大鼠肝再生的影響. 中華實驗外科雜志, 2019, 36(3): 455-457.
21. 方兆山, 楊劍, 龐玨, 等. 3D 腹腔鏡 Glisson 蒂橫斷式肝切除術治療肝癌對機體細胞免疫功能的影響. 實用醫學雜志, 2018, 34(12): 2004-2006, 2011.
22. 陳熙, 胡朝輝, 彭永海, 等. 控制性低中心靜脈壓在腹腔鏡肝切除中的應用: 前瞻性隨機對照研究. 中國微創外科雜志, 2018, 18(7): 585-589.
23. 張勝龍, 楊先偉, 王文濤. 泡型肝包蟲病肝切除術后膽漏發生危險因素分析. 中華普通外科雜志, 2020, 35(1): 26-29.
24. 徐亞男, 姜洪池. 肝門部膽管癌肝切除術后肝功能衰竭的危險因素及治療策略. 中華普通外科雜志, 2018, 33(12): 1076-1078.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of round ligament fissure approach in re-hepatectomy

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