经Glisson鞘路径腹腔镜肝切除术的临床研究

晏益核，卢榜裕，蔡小勇等.经Glisson鞘路径腹腔镜肝切除术的临床研究[J].中华普通外科杂志.2013, 28(3):205-207

腹腔镜,肝切除术,Glisson鞘

晏益核，卢榜裕，蔡小勇，黄玉斌，靳小建，雷宇，陈永军，李建军

广西医科大学第一附属医院微创外科,南宁,530021

2013

知网,万方

目的 探讨经Glisson鞘路径行腹腔镜肝切除术的可行性及技术要点.方法 回顾性分析广西医科大学第一附属医院微创外科在2008年5月至2012年5月期间27例应用经Glisson 鞘路径行腹腔镜肝切除术病例的临床资料.结果 本组27例患者中经Glisson鞘路径阻断左肝蒂16例,阻断右肝蒂11例.手术方式包括腹腔镜肝左外叶切除术9例,左半肝切除术6例,右半肝切除术2例,局部性肝切除术10例,其中1例因为离断肝实质过程中肝断面出血而中转开腹手术.平均手术时间(229.07±78.46)min,术中出血(454.81±388.22)ml.输注红细胞(1.74±2.46)U,血浆(162.96±235.58) ml.术后住院时间(12.41±3.86)d.术后2～3d进流质饮食,2～4d肛门排气,3 ～4d下床活动.术后肝功能血清转氨酶、胆红素及白蛋白的检测结果7～14d后恢复正常.术后并发症包括腹水2例,胸腔积液1例,胆漏1例,均经过内科保守治疗后痊愈出院.截止2012年5月,24例肝癌患者术后获得随访,随访时间1～49个月,平均(21.0±11.0)个月.随访患者的1年生存率75％,3年生存率8.3％.结论 经Glisson鞘路径行腹腔镜肝切除术是可行及有效的. Objective To evaluate the feasibility and technique of trans-intrahepatic Glissoni capsula approach for laparoscopic hepatectomy.Methods Between May 2008 and May 2012,the perioperative and postoperative outcomes of 27 cases undergoing laparoscopic hepatectomy using the intrahepatic Glisson approach at author's department were retrospectively analyzed.Results Left hepatic pedicle was controlled through intrahepatic Glisson pedicle in 16 patients.Right hepatic pedicle was controlled in 11 patients by the same maneuver.Left lateral segmentectomy was performed in 9 patients,left hepatectomy in 6 patients,right hepatectomy in 2 patients,tumor local resection in 10 patients,and conversion to open surgery in 1 patient because of bleeding during the parenchymal transection.There was no operative mortality.The mean operative time was (229.07 78.46) min,mean operative blood loss was (454.81 ± 388.22) ml,concentrate blood cells transfusion volume was (1.74 ± 2.46) U,and plasma transfusion volume was (162.96 ±235.58) ml.The mean postoperative hospital stay was (12.41 ± 3.86)days.The liver function were back to normal level on postoperative 7-14 days.Complications included ascites in 2 patients,pleural effusion in 1 patient,biliary fistula in 1 patient.These complications were cured by conservative therapy.As of May 2012,24 cases with liver cancer were followed-up.The follow-up time ranged from 1 to 49 months and mean time was (21.0 ± 11.0) months,survival rate was 75％ in 1-year and 8.3％ in 3-year.Conclusions The trans-Glissoni capsula fibrosa approach used for laparoscopic hepatectomy is feasible and effective.