Glisson蒂横断式解剖性肝切除120例治疗体会

摘要

Objective To investigate the application value of Glisson pedicle transection anatomical liver resection. Methods Retrospective analysis was conducted in 120 patients undergone Glisson pedicle transec-tion anatomical liver resection in the People's Hospital of Lincang from Jan. 2014 to Mar. 2017. Among 120 patients, there were 65 cases of primary liver cancer, cholangiocarcinoma in 4 cases, hilar cholangiocarcinoma in 4 cases, gallbladder carcinoma in 6 cases, intrahepatic bile duct stone in 33 cases, hepatic hemangioma in 8 cases, and hepatic parasitic disease in 10 cases. I segment was resected in 3 cases, 1+II segment resection in 1 case, 1+II+III+IV segment resection in 1 case, I+II+III+IV+V+VIII segment resection in 1 case, II+III+VI+VIII segment resection in 1 case, left lateral lobe (II+III) resection in 33 cases, left half liver (II+III+IV) resec-tion in 22 cases, left clover (II+III+IV+V+VIII) resection in 3 cases, IVb+V segment resection in 6 cases, IV+V+VIII segment resection in 3 cases, right hepatectomy (V+VI+VII+VIII) in 25 cases, right trilobectomy (IV+V+VI+VII+VIII) in 3 cases, right anterior lobe (V+VIII) resection in 5 cases, VI segment resection in 2 cases, right after lobectomy (VI+VII) in 4 cases, VII segment resection in 2 cases, VIII resection in 4 cases. Nine cases were treated with simultaneous Roux-Y surgery. Results All 120 cases were completed operation , The average intraoperative blood loss was 630 mL and the mean operative duration was 3.7 h. Postoperative compli-cations occurred in 34 cases (28.33%), including bile leakage, pleural effusion and multiple drug resistance bac-teria infection. Conclusion Glisson pedicle transection anatomical liver resection is simple, fast and safe, which can significantly reduce bleeding, improve the curative effect. This is an alternative surgical approach.%目的 探讨Glisson蒂横断式解剖性肝切除术的应用价值.方法 回顾性分析临沧市人民医院2014年1月至2017年3月行Glisson蒂横断式解剖性肝段切除术120例患者的临床资料.其中原发性肝癌65例,胆管细胞癌4例,肝门部胆管癌4例,胆囊癌6例,肝内胆管结石33例,肝血管瘤8例,肝寄生虫病10例.采用Glisson蒂横断式解剖性肝切除I段切除3例,I+II段切除1例,I+II+III+IV段切除1例,I+II+III+IV+V+VIII段切除1例,II+III+IV+VIII段切除1例,II+III+V+VI+VII+VIII段切除1例,左外叶(II+III段)切除33例,左半肝(II+III+IV段)切除22例,左三叶(II+III+IV+V+VIII段)切除3例,IVb+V段切除6例,IV+V+VIII段切除3例,右半肝切除(V+VI+VII+VIII段)25例,右三叶切除(IV+V+VI+VII+VIII段)3例,右前叶(V+VIII段)切除5例,VI段切除2例,右后叶切除术(VI+VII段)4例,VII段切除2例,VIII段切除4例.其中9例同时行肝管空肠Roux-Y吻合术.结果 全组均完成手术.术中平均出血量630 mL.平均手术时间3.7 h.术后发生并发症34例(28.33%),为胆漏、胸腔积液、多重耐药菌感染等.结论 Glisson蒂横断式解剖性肝切除术操作简便,快速安全,能明显减少出血,提高疗效,是一种可选择的手术方式.