Abstract: Objective:To investigate the clinical effect of fissure for ligamentum teres hepatic (LTH) approach in hepatectomy.
Methods:The method of crosssectional study was adopted. The clinical data of the 85 patients undergoing hepatectomy through fissure for LTH approach who were admitted to the West China Hospital of Sichuan University from February 2009 to December 2013 were collected. Among all the 85 cases, there were 61 of hepatocellular carcinoma, 12 of intrahepatic bile duct stones, 6 of bile duct cellular carcinoma and 6 of metastatic hepatic carcinoma. The operations involved dissecting fissure for LTH, dealing with portal vein, hepatic artery and bile duct inside the fissure, lowering the hepatic portal, mutilating hepatic parenchyma, and undergoing the hepatic left lateral lobectomy, left hemihepatectomy, mesohepatectomy, hepatic left and-/or right trisegmentectomy. Operation method, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative drainagetube removal time and complications were recorded. The followup including recurrence and metastasis of tumor and survival of patients was conducted by outpatient examination and telephone interview up to August 2015. Measurement data with normal distribution were presented as ±s. Measurement data with skewed distribution were presented as M (range). The survival rate was caculated by KaplanMeier method.
Results:The 85 cases of hepatectomy were successfully completed through fissure for LTH approach, including 19 cases of hepatic left lateral lobectomy (9 with hepatocellular carcinoma, 6 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 20 cases of left hemihepatectomy (8 with hepatocellular carcinoma, 5 with intrahepatic bile duct stones, 4 with bile duct cellular carcinoma, 3 with metastatic hepatic carcinoma), 5 cases of left hemihepatectomy+caudate lobectomy (3 with hepatocellular carcinoma, 1 with intrahepatic bile duct stones, 1 with bile duct cellular carcinoma), 14 cases of mesohepatectomy (14 with hepatocellular carcinoma) and 27 cases of hepatic left and-/or right trisegmentectomy due to hepatocellular carcinoma (15 of hepatic left trisegmentectomy and 12 of hepatic right trisegmentectomy). No perioperative death occurred. The median operation time was 280 minutes (range, 95- 430 minutes). The median volume of intraoperative blood loss was 450 mL (range, 200-3 200 mL).There were 18 cases of intraoperative blood infusion. The postoperative peritoneal drainagetube removal time was 3 days (range, 2 -5 days). Eleven patients with postoperative complications recovered after symptomatic conservative treatment, including 6 with lung infection, 4 with peritoneal effusion and 1 with abdominal infection. There was no case of intraabdominal bleeding, bile leakage or hepatic failure. No patient died within 1 month after operation. Seventynine patients were followed up for a median time of 38 months (range, 18-53 months) with a followup rate of 92.9%(79/85). The 1year overall survival rate and 1year diseasefree survival rate were 79.0% and 65.0%, and the 3year overall survival rate and 3year diseasefree survival rate were 56.0% and 34.0%, respectively.
Conclusion:Hepatectomy through fissure for LTH approach is safe, effective and easily operable, with a good shortterm outcome.