经Glisson蒂鞘内解剖性肝切除术在原发性肝癌治疗中的应用

摘 要] 目的 探讨经Glisson蒂鞘内解剖性肝切除术在原发性肝细胞癌（HCC）治疗中的应用价值。方法 回顾性分析2013 年8 月2016 年8 月湖北省中西医结合医院肝胆外科应用经Glisson蒂鞘内解剖性肝切除术治疗105 例HCC患者的临床资料。结果 所有病例均成功实施经Glisson蒂鞘内解剖性肝切除术，其中行肝左外叶切除术（II+III段）19例，左半肝切除术（II+III+IV段）33例，肝右前叶切除术（V+VIII段）15例，肝右后叶切除术（VI+VII段）17 例，右半肝切除术（V+VI+VII+VIII段）21 例。术后患者出现切口脂肪液化13例，肺部感染8例，胸腔积液10例，肝功能不全11例，保守治疗后均痊愈。术后无肝功能衰竭及死亡患者。随访1 年观察，12 例患者失访，剩余93 例患者复发9 例。结论 经Glisson蒂鞘内解剖性肝切除，术中选择性离断目标血管，依据肝组织缺血淤血的范围，选择正确的离断平面，实现肿瘤精准切除。该术式不仅减轻剩余肝组织的损伤，而且能够有效避免肝功能衰竭的发生，便于术后肝功能恢复，值得临床推广应用。

The application of anatomic hepatectomy through Glisson pedicle for treatment of primaryhepatocellular carcinoma

Abstract Objective To evaluate the effect of anatomic hepatectomy through Glisson pedicle for primaryhepatocellular carcinoma (HCC). Methods Retrospective analysis was carried out to analyze the clinical dataof 105 cases with HCC undergoing anatomic hepatectomy by Glisson predicle in Hubei Provincial Hospitalof Integrated Chinese and Western Medicine between Aug. 2013 to Aug. 2016. Results All patients weresuccessfully operated with anatomic hepatectomy by Glisson predicle, including left lobectomy (II+III section)in 19 cases, left hepatectomy (II+III+IV section) in 33 cases, right anterior lobe resection (V+VIII section) in15 cases, right posterior lobectomy (VI+VII section) in 17 cases, and the right liver resection (V+VI+VIII+VIIsection) in 21 cases. After operation, 13 cases emerged incision fat necrosis, 8 cases occurred pulmonaryinfection, 10 cases got pleural effusion and 11 cases obtained hepatic insufficiency. Problem cases were curedafter conservative treatment and no liver failure and death appeared. After 1-year follow-up, 12 cases were lost;and among the remaining 93 cases, 9 cases relapsed. Conclusion With anatomic hepatectomy through Glissonpedicle, target vessel is selectively removed during operation; and according to the extent of hepatic ischemia andcongestion, the correct off plane is selected, thus precise excision of hepatocellular carcinoma is achieved. Thissurgical procedure could not only alleviate the damage of the rest liver tissues, but also effectively prevents theoccurrence of liver failure.