经Glisson途径切除肝中叶治疗原发性肝癌

Intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors

目的探讨经肝内Glisson系统入路对合并肝硬化的肝癌病人行肝中叶切除术。方法对2005年5月至2007年12月中南大学湘雅二医院肝胆外科实施24例经肝内Glisson系统入路肝中叶切除术的肝癌病人进行回顾性分析。结果24例经肝内Glisson系统入路肝中叶切除术均安全实施，未发生术中大出血。平均手术时间（258±60）min，平均术中失血量300（200～1200）mL，仅2例输血400mL。术后发生胆漏3例。膈下感染2例。经保守治疗痊愈。无院内死亡病例。结论经肝内Glisson途径的肝中叶切除术治疗合并肝硬化肝癌安全有效，掌握手术技巧是关键。

Objective To evalualte intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors. Methods The clinical data of 24 cirrhotic patients with primary liver tumor admitted from May 2005 to December 2007 at the Second Xiangya Hospital of Central South University were analyzed retrospectively. Results Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation. The estimated intraoperative mean amount of blood loss was 300mL （range 200 to 1200mL）, The mean operating time was （258_＋60） minutes and only 2 patients required blood transfusion for 2U. Minor postoperative complications included bile leakage in 3 cases, subphrenic infection in 2 cases and resolved with conservative management. No hospital mortality occurred. Conclusion Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the pringle maneuver.