改良Glisson肝蒂法在精准肝切除术中的应用  

The Clinical Study of Using Modified Glisson Pedicle Transection Method in The Precise Hepatectomy of Hepatocellular Carcinoma

作　　者：冯伟[1] 林斌[1] 仇毓东[2] 陈政[1] 汪启乐 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院肝胆外科,江苏宿迁223800 [2]南京大学医学院附属鼓楼医院肝胆外科,江苏南京210008

出　　处：《中国普外基础与临床杂志》2013年第7期762-767,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨改良Glisson肝蒂法在肝癌患者肝切除术中应用的可行性。方法对60例肝切除术后病理学检查证实的肝细胞癌患者进行分组研究。实验组(Glisson组)经过术前精确评估后,术中采取改良Glisson肝蒂法首先阻断肝段肝蒂,然后按照术中B超定位肝静脉主干及分支作为肝内断肝平面,采取精细钳夹法切除单一以及联合肝段。对照组(Prigle组)行常规术前检查及评估,术中采取传统Prigle法阻断第一肝门后,以超声刀不显露肝静脉按照术中B超定位平面切除单一或联合肝段。结果术中出血量、输血量、手术时间和术后肝功能指标、术后恢复时间及术后白蛋白用量2组间差异均无统计学意义(P>0.05);Glisson组术后并发症发生率(23.3%)低于Prigle组(50.0%),P<0.05;Glisson组术后病理标本切缘距肿瘤距离为(2.3±0.7)cm,大于Prigle组的(1.5±0.6)cm,P<0.05。Glisson组术后1年的肿瘤复发率略低于Prigle组〔10.0%(3/30)比16.7%(5/30)〕,但差异没有统计学意义(P>0.05)。结论改良Glisson肝蒂法肝切除在肝癌患者中的应用具有与传统Prigle法同样的安全性,且可减少术后并发症的发生,保证手术切缘,同时理论上可以降低术后复发率。Objective To explore the safety and feasibility of using modified Glisson pedicle transection method in the precise hepatectomy of hepatocellular carcinoma（HCC）.Methods Sixty patients with HCC,which confirmed by postoperational pathology were admitted in the study.During the surgery of experimental group（Glisson group）,the segment pedicle were transected firstly using modified Glisson pedicle transection method.Then,the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound.During the surgery of contrast group（Prigle group）,the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar.Results There were no significant difference in the amount of intraoperative bleeding,blood transfusion,as well as duration of surgery,serum alanine aminotransferase,total bilirubin,and length of hospital stay between the two groups（P0.05）.However,the incidence of postoperative complication was lower in Glisson group（23.3% vs.50.0%,P0.05）.In addition,the length of tumor margin was more favorable in Glisson group〔（2.3±0.7）cm vs.（1.5±0.6）cm,P 0.05〕.The recurrence rate of Glisson group was lower than that Prigle group,but was not different significantly（P 0.05）.Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC.And it has the advantages in lower postoperative complication and more favorable tumor margin,which may reduce the recurrence rate theoretically.

关 键 词：Glisson肝蒂法 精准肝切除术 肝细胞癌 

分 类 号：R657.3[医药卫生—外科学]