肝实质解剖优先法对比肝蒂优先法在腹腔镜右半肝切除中的应用OA北大核心CSTPCD

Background and Aims:Laparoscopic right hemihepatectomy(LRH)is a complex minimally invasive liver resection surgery that requires a long learning curve.Traditional LRH procedure adheres to the practice of"pedicle-first and intrathecal dissection"used in open liver resection,which involves first dissociating the right hepatic artery,right portal vein,and right bile duct after removing the gallbladder,then severing them before dividing the liver parenchyma.However,this method is time-consuming and labor-intensive and carries a risk of bleeding if not performed correctly.The authors have developed a technique during prior clinical work that prioritizes liver parenchymal dissection before handling the target hepatic pedicle,named the"liver parenchyma dissecting-first"(LPDF)method.This method does not change the extent of the resection but adjusts the order of the procedure.Preliminary experience suggests that it simplifies the hemihepatectomy process and facilitates the broader application of LRH.This study was peformed to further explore the advantages of LPDF over the pedicle-first method in LRH. Methods:Using a prospective study approach,eligible liver cancer patients who underwent LRH in Xiangya Hospital of Central South University from August 2021 to August 2023 were randomly divided into observation group and control group.Patients in the observation group underwent the LPDF method during surgery,while those in the control group used the pedicle-first method.Perioperative clinical variables were collected and compared between the two groups. Results:A total of 19 patients were included,with 10 in the observation group and 9 in the control group.There were no statistically significant differences in baseline data between the two groups(all P＞0.05).The operative time in the observation group was significantly shorter than that in the control group(224.30 min vs.267.78 min,P=0.045).Other variables,including intraoperative blood loss and transfusion volume,rate of conversion to open surgery,time to postoperative gas passage,length of hospital stay,liver function on the third postoperative day,and incidence of complications,as well as the recurrence-free survival rate,and overall survival rate,showed no statistically significant differences between the two groups(all P＞0.05). Conclusion:The application of LPDF in LRH simplifies the pedicle handling process compared to the traditional pedicle-first method,shortens the operative time,does not increase the incidence of postoperative complications,and somewhat reduces the risk of bleeding.Further large-sample studies and promotion are recommended.