Glisson蒂横断式腹腔镜左肝外叶切除术八例报告

Laparoscopic left lateral sectionectomy using the Glissonian pedicel approach： a study of 8 patients

目的探讨Glisson蒂横断式腹腔镜左肝外叶切除术的可行性与安全性。方法显露肝圆韧带根部，自肝圆韧带根部左缘开始，采用腹腔镜多功能手术解剖器（LPMOD）整体解剖左肝外叶Glisson蒂，依次游离左肝外叶Glisson蒂至Ⅱ、Ⅲ段分支，予以夹闭、切断。离断Glisson蒂分支后，可见其支配区域因缺血而变暗，再切除其支配区域的肝组织。如此反复离断约4～6条左肝外叶Glisson蒂至Ⅱ、Ⅲ段分支，同时切断左肝静脉及其属支，完成Glisson蒂横断式腹腔镜左肝外叶切除术。结果8例均成功完成Glisson蒂横断式腹腔镜左肝外叶切除术，无中转开腹。手术时间110～190（151．0±35．4）min，其中解剖左肝外叶Glisson蒂分支及切肝时间为70～135（101．0±24．1）min，术中出血100～300（210．0±89．4）ml，均未输血。术后丙氨酸转氨酶（ALT）升高值35～102（75．4±26．5）U／L，恢复正常时间2～6（3．0±1．7）d，术后住院时间6～10（8．2±1．6）d，无并发症发生。结论Glisson蒂横断式腹腔镜左肝外叶切除术是安全可行的。

Objective To study the safety and feasibility of laparoscopic left lateral sectionecto- my using the Glissonian pedicel approach. Methods The root of the round ligament of the liver was exposed and the Glissonian pedicel of the left lateral section was dissected, starting from left and using the laparoscopic Peng＇s multifunctional operative dissector （LPMOD）. After the Glissonian pedicel of segment 1I and Ill was dissected, clipped and cut, the ischemic boundary showed up. The liver was transeeted at the boundary of the ischemic liver, and the left hepatic vein and its branches were cut. Results The surgery was successfully performed in 8 patients. There was no conversion to open oper- ation. The operative time was 110--190 （151.0±35.4） min. The time of Glissonian pedicel dissection and liver resection was 70-- 135 （101.0 ± 24.1） min. Operative blood loss was 100- 300 （210.0 4- 89.4） ml. The ALT increased by 35-102 （75.4±26.5） U/L after operation and decreased to a nor- mal level in 2--6 （3.0±1.7） d. The postoperative hospital stay was 6--10 （8.24-1.6） d. There was no major complication. Conclusion Laparoscopic left lateral sectionectomy using the Glissonian pedi- cel approach is safe and feasible.