基于右前肝蒂、右后肝蒂和肝右静脉之间类三角区域的Glisson蒂入路在腹腔镜解剖性右侧肝段切除术中的应用  

Application of the Glissonean pedicle approach based on the triangular area among the right anterior pedicle,the right posterior pedicle and the right hepatic vein in laparoscopic anatomical resection of right hepatic segments

作　　者：肖永刚 张吉祥 王黎明 荣维淇 吴凡 蒙轩 吴健雄 王宏光 Xiao Yonggang;Zhang Jixiang;Wang Liming;Rong Weiqi;Wu Fan;Meng Xuan;Wu Jianxiong;Wang Hongguang(The Second Ward of Hepatobiliary Surgery,Guizhou Province Qianxinan People's Hospital,Xingyi 562400,China;Department of Hepatobiliary Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]贵州省黔西南州人民医院肝胆外科二病区,兴义562400 [2]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京100021

出　　处：《中华肝胆外科杂志》2022年第8期592-596,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2020A26)。

摘　　要：目的探讨基于右前肝蒂、右后肝蒂和肝右静脉(APR)之间的类三角区域(APR三角)入路、荧光反染的右侧解剖性肝切除术在腹腔镜解剖性肝切除术中的应用。方法回顾性分析2020年9月至2021年9月在中国医学科学院北京协和医学院肿瘤医院接受腹腔镜解剖性右侧肝段切除术治疗的34例肝脏肿瘤患者的临床资料,其中男性24例,女性10例,年龄(58.3±10.3)岁。收集患者手术完成情况、手术时间、术中出血量、术中输血、术后并发症、术后住院时间等资料。结果34例均为肝脏恶性肿瘤,均在全腹腔镜下顺利完成手术,无中转开腹手术者。其中V段切除3例,VI段切除3例,VII段切除5例,V段+VI段2例,VI段+VII段9例,V段+VIII段3例,V段背段+VI段+VII段5例,右后区+前背段3例,前背段1例。手术时间为(275.58±82.28)min,术中出血量为100(100,300)ml,术中均无输血患者。术后第1天开始进食流质食物,术后第2~3天下床活动。术后并发症的Clavien-Dindo分级I级32例,III级2例。术后住院时间为(7.23±3.10)d。肿瘤切缘均为阴性。34例患者均获得随访,随访时间(8.94±2.94)个月。截至随访结束,34例患者均存活,未见肿瘤复发。结论基于"APR三角"的右侧Glisson蒂入路、离断后荧光反染的右侧解剖性肝切除术安全可行。Objective To study the use of the Glissonean pedicle approach based on the triangular area among the right anterior pedicle,the right posterior pedicle and the right hepatic vein("APR triangle"),followed by indocyanine green fluorescence negative staining in laparoscopic anatomical resection of right hepatic segments.Methods The clinical data of 34 patients with liver tumors who underwent laparoscopic anatomical right hepatic segmentectomy at the Chinese Academy of Medical Sciences and Peking Union Medical College from September 2020 to September 2021 were analyzed retrospectively.Of the 34 patients,there were 24 males and 10 females,aged(58.3±10.3)years old.Data on completion of operation,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications and postoperative hospital stay were collected.Results All the 34 patients had malignant liver tumors,and they were successfully operated using total laparoscopic surgery.There was no conversion to open surgery.Three patients underwent segment V resection,3 patients segment VI resection,5 patients segment VII resection,2 patients segment V+segment VI resection,9 patients segment VI+segment VII resection,3 patients segment V+segment VII resection,5 patients segment V dorsal segment+segment VI+segment VII resection,3 patients right posterior section resection+anterior dorsal segment resection and 1 patient anterior dorsal section resection.The operation time was(275.58±82.28)min,the amount of intraoperative blood loss was 100(100,300)ml,and there were no patients requiring blood transfusion during the operation.Liquid food was started on the first day after operation,and out-of bed activities were carried out on the second to third days after operation.The Clavien Dindo classification of postoperative complications was grade I in 32 patients and grade III in 2 patients.The postoperative hospital stay was(7.23±3.10)d.All tumor margins were negative for malignancy.All the 34 patients were followed-up for(8.94±2.94)months.By the

关 键 词：腹腔镜检查 肝切除术 Glisson蒂入路 

分 类 号：R657.3[医药卫生—外科学]