Glisson蒂横断式解剖性肝切除120例治疗体会

目的探讨Glisson蒂横断式解剖性肝切除术的应用价值。方法回顾性分析临沧市人民医院2014年1月至2017年3月行Glisson蒂横断式解剖性肝段切除术120例患者的临床资料。其中原发性肝癌65例,胆管细胞癌4例,肝门部胆管癌4例,胆囊癌6例,肝内胆管结石33例,肝血管瘤8例,肝寄生虫病10例。采用Glisson蒂横断式解剖性肝切除Ⅰ段切除3例,Ⅰ+Ⅱ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅳ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段切除1例,左外叶(Ⅱ+Ⅲ段)切除33例,左半肝(Ⅱ+Ⅲ+Ⅳ段)切除22例,左三叶(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段)切除3例,Ⅳb+Ⅴ段切除6例,Ⅳ+Ⅴ+Ⅷ段切除3例,右半肝切除(Ⅴ+Ⅵ+Ⅶ+Ⅷ段)25例,右三叶切除(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段)3例,右前叶(Ⅴ+Ⅷ段)切除5例,Ⅵ段切除2例,右后叶切除术(Ⅵ+Ⅶ段)4例,Ⅶ段切除2例,Ⅷ段切除4例。其中9例同时行肝管空肠RouxY吻合术。结果全组均完成手术。术中平均出血量630 mL。平均手术时间3.7 h。术后发生并发症34例(28.33%),为胆漏、胸腔积液、多重耐药菌感染等。结论 Glisson蒂横断式解剖性肝切除术操作简便,快速安全,能明显减少出血,提高疗效,是一种可选择的手术方式。

Experience of Glisson pedicle transection anatomical liver resection in 120 patients

Objective To investigate the application value of Glisson pedicle transection anatomical liver resection. Methods Retrospective analysis was conducted in 120 patients undergone Glisson pedicle transec-tion anatomical liver resection in the People's Hospital of Lincang from Jan. 2014 to Mar. 2017. Among 120 patients, there were 65 cases of primary liver cancer, cholangiocarcinoma in 4 cases, hilar cholangiocarcinoma in 4 cases, gallbladder carcinoma in 6 cases, intrahepatic bile duct stone in 33 cases, hepatic hemangioma in 8 cases, and hepatic parasitic disease in 10 cases. I segment was resected in 3 cases, 1+II segment resection in 1 case, 1+II+III+IV segment resection in 1 case, I+II+III+IV+V+VIII segment resection in 1 case, II+III+VI+VIII segment resection in 1 case, left lateral lobe (II+III) resection in 33 cases, left half liver (II+III+IV) resec-tion in 22 cases, left clover (II+III+IV+V+VIII) resection in 3 cases, IVb+V segment resection in 6 cases, IV+V+VIII segment resection in 3 cases, right hepatectomy (V+VI+VII+VIII) in 25 cases, right trilobectomy (IV+V+VI+VII+VIII) in 3 cases, right anterior lobe (V+VIII) resection in 5 cases, VI segment resection in 2 cases, right after lobectomy (VI+VII) in 4 cases, VII segment resection in 2 cases, VIII resection in 4 cases. Nine cases were treated with simultaneous Roux-Y surgery. Results All 120 cases were completed operation , The average intraoperative blood loss was 630 mL and the mean operative duration was 3.7 h. Postoperative compli-cations occurred in 34 cases (28.33%), including bile leakage, pleural effusion and multiple drug resistance bac-teria infection. Conclusion Glisson pedicle transection anatomical liver resection is simple, fast and safe, which can significantly reduce bleeding, improve the curative effect. This is an alternative surgical approach.