腹腔镜下Glisson蒂横断式解剖性肝切除的应用价值  

Application of transection of glissionean sheath for laparoscopic anatomic liver resection

作　　者：谭新华[1] 张文兴[1] 刘鹏[1] 黄湘俊[1] 彭书旺 

机构地区：[1]湖南中医药大学第一附属医院肝胆外科,湖南长沙410007

出　　处：《中国内镜杂志》2018年第2期90-93,共4页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜下Glisson蒂横断式解剖性肝切除技术的安全性及应用价值。方法完全腹腔镜下鞘外解剖、阻断相应肝段、肝叶的Glisson蒂,按解剖学标志切除肝段、肝叶共20例。其中,原发性肝癌12例,肝内胆管结石4例,肝脏血管瘤2例,肝脏局灶结节性增生1例,肝腺瘤1例。结果 20例手术在完全腹腔镜下完成Glisson蒂横断式解剖性肝切除,其中左半肝(Ⅱ、Ⅲ、Ⅳ段)切除6例、左外叶(Ⅱ、Ⅲ段)切除5例、右半肝(Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除3例、右前叶下段(Ⅴ段)切除1例、右后叶下段(Ⅵ段)切除2例和右后叶(Ⅵ、Ⅶ段)切除3例。手术时间(144.77±24.68)min,出血量(279.00±132.70)ml。术后住院(8.22±1.40)d,术后发生胆漏及膈下脓肿各1例,均经非手术治疗痊愈,未发生术后出血等其他严重并发症。结论腹腔镜Glisson蒂横断式肝切除有助于控制术中出血,较好地解决了腹腔镜下肝段以上肝切除时边界难确定及出血等问题,可安全用于肝脏肿瘤解剖性肝切除术。Objective To study the clinical value of transection of Glissonean sheath for laparoscopic anatomic liver resections. Methods The patients of liver resections using laparoscopic Glissonean sheath-transection anatomy technology were 20 cases with liver lesions including 12 cases of primary liver cancer, 4 cases of intrahepatic bile duct stones, 2 cases of liver hemangioma,1 case of focal nodular hyperplasia of the liver （FNH） and 1 case of hepatocellular adenomas （HCAs）. Results Surgical procedures included segment Ⅱ , Ⅲ , Ⅳ in 6 cases, segmentⅡ, Ⅲ in 5 cases, segmentⅤ, Ⅵ, Ⅶ, Ⅷ in 3 case, segmentⅤ in 1 case, segment Ⅵ in 2 cases, segment Ⅵ , Ⅶ in 3 cases. Mean operation time is （144.77 ± 24.68） min. The mean blood loss in operation is （279.00 ± 132.70） ml. The mean postoperative hospital stay is （8.22 ± 1.40） d. Biliary fstula occurred in 1 case, subphrenic infection occurred in 1 case,and it was cured with medical therapy. No postoperative complications such as bleeding occurred. Conclusion Based on these preliminary results, we conclude that laparoscopic Glissonean sheath-transection technology for liver resection can be well applied in laparoscopic liver segment resection above liver resection avoiding problems such as instant bleeding and manipulation of ducts, can be carried out safely and effectively by experienced laparoscopists in selected cases, of whose liver lesions were located in left liver lobe and some segments of right liver lobe.

关 键 词：腹腔镜 肝切除 肝脏 

分 类 号：R657.3[医药卫生—外科学]