高清腹腔镜下Glisson蒂横断式肝左外叶切除术治疗肝细胞癌的临床疗效  

Clinical experience of high-definition laparoscopic Glisson pedicle transverse resection of the left lateral lobe of the liver

作　　者：刘爽 吴涯昆 Liu Shuang;Wu Yakun(Department of Hepatobiliary Surgery,Suining Central Hospital Affiliated to Chongqing Medical University,Sichuan Suining 629000,China)

机构地区：[1]重庆医科大学附属遂宁市中心医院肝胆外科,四川遂宁629000

出　　处：《中国医刊》2022年第6期637-641,共5页Chinese Journal of Medicine

基　　金：四川省卫生和计划生育委员会科研课题(17ZD020)。

摘　　要：目的探讨高清腹腔镜下Glisson蒂横断式肝左外叶切除术治疗肝细胞癌的临床疗效。方法选择2016年6月至2020年6月重庆医科大学附属遂宁市中心医院肝胆外科收治的61例肝左外叶肝细胞癌患者,根据手术方式的不同分为对照组(29例,采用高清腹腔镜下传统Pringle法肝左外叶切除术治疗)和观察组(32例,采用高清腹腔镜下Glisson蒂横断式肝左外叶切除术治疗)。比较两组患者的围术期情况、肝功能情况、肿瘤标志物水平、并发症发生率及远期生存率。结果对照组的手术时间及住院总时长明显长于观察组,术中出血量及输血率明显高于观察组,差异有显著性(P<0.05)。术前两组肝功能比较差异无显著性(P>0.05),术后1、3、7d对照组丙氨酸转氨酶、天冬氨酸转氨酶水平明显高于观察组(P<0.05),而总胆红素、白蛋白水平两组比较差异无显著性(P>0.05);术后1、3、7d两组丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素水平均随时间延长明显降低(P<0.05),而白蛋白水平无明显变化。观察组术后肿瘤标志物甲胎蛋白、癌胚抗原及糖类抗原19-9的下降值均明显大于对照组,差异有显著性(P<0.05)。对照组术后并发症发生率(31.03%)明显高于观察组(9.38%),差异有显著性(P<0.05)。术后随访3~18个月,观察组中位生存时间(14个月)明显长于对照组(8个月),且远期生存率明显高于对照组,差异有显著性(P<0.05)。结论高清腹腔镜下Glisson蒂横断式肝左外叶切除术治疗肝细胞癌具有操作简单方便、术中输血率低、术后并发症少、远期生存率高等优点,值得临床应用。Objective To investigate the clinical effect of high-definition laparoscopic Glisson pedicle transverse left lateral hepatectomy in the treatment of hepatocellular carcinoma.Method Seventy-six patients with hepatocellular carcinoma in the left lateral lobe of the liver were divided into control group(34 cases treated with Pringle hepatectomy under traditional high-definition laparoscopy)and observation group(42 cases treated with Glisson pedicle transverse hepatectomy under high-definition laparoscopy).The perioperative condition,liver function,tumor markers,complication rate and long-term survival rate were compared between the two groups.Result Both groups were followed up for 3-18 months.The operation time and total length of hospitalization in control group were significantly higher than those in observation group.at the same time,the intraoperative blood transfusion rate in control group was as high as 30.95%,which was significantly higher than that in observation group by 11.76%(P<0.05).There was no significant difference in preoperative liver function between the two groups.After operation,ALT and AST in control group were significantly higher than those in observation group(P<0.05),but there was no significant difference in TB and ALB between the two groups.Compared with the same group,alt,AST and TB improved significantly with time(P<0.05),but ALB did not change significantly.The difference of tumor markers in observation group was significantly higher than that in control group(P<0.05).The incidence of postoperative complications in control group was 31.03%,which was significantly higher than that in observation group(9.38%,P<0.05).The long-term overall survival rate in observation group was significantly higher than that in control group.The median survival time in observation group(14 months)was significantly better than that in control group(8 months).Conclusion High-definition laparoscopic Glisson pedicle transverse left lateral hepatectomy has the characteristics of simple and convenient operation,

关 键 词：高清腹腔镜 肝细胞癌 Glisson蒂横断式肝左外叶切除术 Pringle法肝左外叶切除术 

分 类 号：R735.7[医药卫生—肿瘤]