Glisson蒂横断式原位肝切除在肝细胞癌治疗中的应用

目的 探讨Glisson蒂横断式原位肝切除在肝细胞癌外科治疗中的价值.方法 回顾性分析2011年1月至2014年3月由同一医疗组手术治疗的71例肝细胞癌病人的临床资料,其中行Glisson蒂横断式原位肝切除37例,常规肝切除术34例.结果 两组病人均无肝性脑病出现,两组手术时间、术后1年内死亡率及术后腹腔出血结果差异无统计学意义（P＞0.05）;Glisson组术中出血量（325.7±32.60） ml,顽固性腹水2例,胆汁漏1例,肿瘤切缘阳性1例术后第3天及第7天ALT、ALB、TBIL及术后住院日（10.95±0.3592）d均优于传统组,结果差异有统计学意义（P＜0.05）.结论 Glisson蒂横断式原位肝切除术较常规肝门阻断式肝切除出血量少,更容易确定肝切除界面,术后肝功能恢复快,胆汁漏及切缘肿瘤阳性率低,可缩短病人平均住院日,而未明显延长手术时间.

Retrograde hepatectomy with glissonean pedicle transection in the treatment of hepatocellular carcinoma

Objective To evaluate the application of retrograde hepatectomy with glisson pedicle transection for hepatocellular carcinoma.Methods Retrospective reviews were conducted for the clinical data of 71 patients undergoing hepatectomy at our department by the same group from January 2011 to March 2014.Both retrograde hepatectomy with glissonean pedicle transaction （n =37） and routine hepatectomy （n =34） were performed.Results No hepatic encephalopathy occurred.There was no significant inter-group differences in surgical duration or postoperative intraperitoneal hemorrhage （P＞0.05）.However,significant differences existed in volume of intraoperative bleeding,albumin,alanine transaminase （ALT） and total bilirubin （TBIL） at Days 3 and 7 post-operation.And statistically significant differences existed in positive rate of tumor margin,postoperative hospitalization stays and rates of bile leakage and refractory ascites （P＜0.05）.Conclusions Retrograde hepatectomy with Glissonean pedicle transection for liver resection determines the demarcation line of hepatectomy easily and causes less intraoperative bleeding.With lower rates of tumor margin,bile leakage and refractory ascites,it has fewer postoperative hospitalization days and no longer operative duration than routine hepatectomy.