Glisson氏鞘外横断式肝段切除术治疗原发性肝癌

Segmental resection of the liver by Glissonean pedicle transection for primary liver cancer

目的探讨Glisson氏鞘外横断式肝段切除术治疗原发性肝癌的临床效果。方法将2006年4月～2008年5月收治的25例肝癌患者(A组)行Glisson氏鞘外横断式肝段切除术,术后观察手术切缘的阳性率、手术标本的微转移灶、复发率。挑选2006-1～2008-10收治的30例(B组)接受常规肝癌局部切除术的肝癌患者作为对照组。结果A组切缘的阳性率(4.0%)明显低于B组切缘的阳性率(10.0%)。A组瘤外肝组织微转移灶的数量(16)明显高于B组微转移灶的数量(8)。A组微转移灶扩散的中位距离为6.8mm(2.7～25.6mm),B组微转移灶扩散的中位距离为4.2mm(2.4～9.0mm)。A组1年的复发率(16.0%)明显低于B组1年的复发率(26.7%)。结论Glisson氏鞘外横断式肝段切除术操作简单,可减少肿瘤微转移灶的残留,降低复发率。

Objective To study the clinical effect of segmental resection of the liver using Glissonean pedicle transection for primary liver cancer.Methods The clinical data of 55 primary liver cancer patients admitted from January 2006 to October 2008 were analyzed retrospectively.Twenty-five of the patients underwent segmental resection of the liver by Glissonean pedicle transection（group A）,and 30 underwent routine hepatectomy（group B）.The positivity rate of the resection margin,micrometastasis in the hepatic parenchyma surrounding the lesions and postoperative recurrence rates were investigated.Results The positivity rate of the resection margin was 4.0% in group A,significantly lower than that of group B.The number of histological micrometastasis was significantly higher in group A than in group B（16 vs 8）.The median distance of histological micrometastasis was 6.8 mm（2.7-25.6 mm） in group A and 4.2 mm（2.4-9.0 mm） in group B.The one-year recurrence rate was significantly lower in group A than in group B（16% vs 26.7%）.Conclusion Glissonean pedicle transection for segmental liver resection is a simpler procedure than routine hepatectomy for primary liver cancer and can reduce the number of histological micrometastasis and recurrence rate.