经Glisson鞘左、右半肝血流阻断法在腹腔镜解剖性肝中叶切除术中的应用

目的 比较经Glisson鞘左、右半肝血流阻断法与Pringle法行腹腔镜解剖性肝中叶切除术（LCH治疗肝中叶肝癌的各项围手术期指标差异，评估经Glisson鞘左、右半肝血流阻断法的安全性及可行性。方法 回顾性分析广东省中医院肝胆外科同一医疗团队在2017年7月至2021年5月因肝中叶肝癌分别采用经Glisson鞘左、右半肝血流阻断法与Pringle血流阻断法行完全性LCH的25例肝癌患者临床资料。在LCH过程中，行经Glisson鞘左、右半肝血流阻断法12例（A组），行Pringle血流阻断法13例（B组）。结果两组患者术前的一般情况均无统计学差异（P>0.05）；两组手术持续时间、肝门阻断时间、术中出血量、肿瘤切缘均无统计学差异（P>0.05）。两组术后进食时间、下床活动时间、肛门排气时间、住院时间以及并发症发生率无统计学差异（P>0.05）。在术后肝功能方面，A组术后第1、3、5天的ALT水平显著低于B组[（244.1±128.9）U/L vs (359.1±132.6)U/L,(195.5±77.8)U/L vs (378.0±143.1)U/L,(73.0±...

Left and right hemihepatic vascular occlusion by Glissonean approach in laparoscopic central hepatectomy

Objective To compare the differences of perioperative indexes between the laparoscopic central hepatectomy (LCH) applied with left and right hemihepatic vascular occlusion through by Glissonean approach, and the Pringle maneuver occlusion, and to evaluate the safety and feasibility of left and right hemihepaticvascular occlusion through by Glissonean approach. Methods A total of 25 patients with hepatocellular carcinoma underwent complete LCH between Jul. 2017 and May 2021 were retrospectively analyzed. In LCH, left and right hemihepatic vascular occlusion through by Glissonean approach was applied in12 cases (group A), pringle maneuver occlusion was applied in 13 cases (group B). Results There was no significant difference in preoperative general conditions between the two groups. There was no significant difference in operation time, time of hepatic portal occlusion, intraoperative blood loss, or tumor margin between the two groups. And the short-term indexes after surgery (time to ambulation, time to flatus, time to liquid and soft diet, hospitalization time, and complication incidence) were not significantly different between the two groups. In terms of postoperative liver function, ALT levels in group A were significantly lower than those in group B on 1st, 3rd and 5th day after operation [(244.1±128.9)U/L vs (359.1±132.6)U/L, (195.5±77.8)U/L vs (378.0±143.1)U/L, (73.0±22.4)U/L vs 153.9±35.9)U/L)]. AST levels in group A were significantly lower than those in group B on 3rd and 5th day after operation [(104.4±58.6)U/L vs (176.3±84.8)U/L, (38.3±11.2)U/L vs (50.6±12.7)U/L], all P<0.05. ConclusionCompared with Pringle maneuver occlusion, left and right hemihepatic vascular occlusion through by Glissonean approach in LCH can reduce postoperative liver function damage, and does not increase intraoperative blood loss, postoperative hospitalization time, or complication incidence. Left and right hemihepatic vascular occlusion through by Glissonean is safe and effective in LCH.