الفهرس 
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Abstract
Hepatocellular carcinoma (HCC) has consistently ranked as the leading cause of cancer death over the past 10 years. At present, liver resection remains the best curative option for HCC. HCC is usually associated with liver cirrhosis. Resection of tumors in a cirrhotic liver is generally more difficult than in a normal liver. Management of HCC in cirrhotic patients remains controversial. Liver transplantation may be best indicated for patients with advanced cirrhosis complicating small HCCs in the absence of active viral replication. The aim of this study was to evaluate the use of Habib4xsealer in comparison with CUSA in resection of HCC in cirrhotic liver regarding intraoperative blood loss and transfusion, time of respectability, time of operation, ICU stay, and hospital stay, postoperative morbidity as bile leek, postoperative hemorrhage, chest infection, wound infection and liver functions. This study was carried out on 40 patients who had liver cirrhosis with child grade A, resectable HCC which was up to 5cm in either right or left lobe of the liver. These forty patients were randomly subdivided into 2 groups, each included 20 patients, group A (patients underwent liver resection) by using ultrasonic dissector (CUSA) and group B (patients underwent liver resection) by using Habib trademark4x sealer. The following results were obtained: Group A included 17males (85%) and 3 females (15%) with a mean age of 54.42±7 (years) as compared to group B which included 16 males (80%) and 4 females (20%) with a mean age of 58.14±16 (years). • All patients in group A had single lesion with a mean diameter of 28.25±32.4 (ml) while in group B, all patients had single lesion with a mean diameter of 14.9± 6.6 (ml) by ultrasonography. Summaru & Conclusion - 120 - • As regard size of tumour by spiral computerized tomography (CT) group A had single lesion with a mean diameter 27.8± 32.5(ml) while in group B, all patients had single lesion with a mean diameter of 14.86± 7.2 (ml) • In group A; nonanatomical resection was done in 13 patients (65%), left lateral segmentectomy in 7 patients (35%). Resection was done by CUSA. • In Group B; nonanatomical resection was done in 12 patients (60%), left lateral segmentectomy was done in 8 patients (40%). Resection was done by Habibtrademark 4x sealer. • Operative blood loss, was it was larger in group A with a mean value of 447.4 ± 45.7 (ml) than that in group B which had a mean value of 65.91 ± 10.84 (ml). It also shows the units of blood transfusion needed for both groups. • Operative blood transfusion, group A needed more units of blood during the operation than group B. • Operative time was longer for group A with a mean value of 308 ± 91.16 than that in group B which had a mean value of 200 ± 37.16 • Respectable time: was longer for group A with a mean value of 90.3 ± 18.6 than that in group B which had a mean value of 44.6 ± 5.55. • Intensive care unit stay: was longer time in group A with a mean value of 3.87 ± 1.57 than that in group B which had a mean value of 2.64 ± 0.73. 121 - • Hospital stay: The hospital stay was longer in group A with a mean duration of 15.04 ± 3.64 compared to that of group B which was 10.54 ± 3.26. • Ten patients (50%) of group A were discharged with child class A versus only 4 patients (20%) in group B. On the other hand, 4 patients (20%) had been changed into class B and one patient (5%) to class C in group B versus 8 (40 %) & 4 (20%) in group A. • The postoperative complications were recorded; as bleeding in group A ,early postoperative bleeding occurred in 3 patients (15.0%), fluid collection (ascitis) was similar in both groups each on had 4 patients (20%), wound infection was reported in 6 patients (30.0%) in group A versus 5 patients (25.%) in group B , bile leak 3 patients (15.0 %) in group A versus 4 patients (20.0%) in group B, other complications as; chest infection in 6 patients of group A (30.%) versus 3 patients in group B (15%). Pleural effusion in 4 patients (20%) of group A versus 2 patients (10%) of group B.