肝蒂横断式肝切除在解剖性肝中叶切除术中的应用

Anatomic central hepatectomy using Glissonean pedicle transection method

目的:评价采用肝蒂横断式肝切除术行解剖性肝中叶切除的安全性和有效性。方法:51例肝中叶原发性肝癌患者按频数匹配原则随机分为传统手术组(n=30)和肝蒂横断式肝切除组(n=21),观察比较两组手术时间、手术失血量、术后肝功能、住院时间、并发症发生率及预后等情况。结果:肝蒂横断式肝切除组与传统手术组比较,手术时间短[(2.7±0.839)h vs.(4.5±0.952)h],术中出血量少[(406±33.182)mL vs.(793±29.677)mL],术后肝功能恢复快[术后7 dALT为(63.048±7.513)U/L vs.(323.667±12.939)U/L],住院时间缩短[(12.528±0.245)d vs.(16.733±0.338)d],并发症发生率低(14.2%vs.40.0%),术后1年肿瘤复发率低[4.8%(1/21)vs.26.7%(8/30)],差异均有统计学意义(均P<0.05)。结论:应用肝蒂横断式肝切除技术行解剖性肝中叶切除安全、有效、微创,值得推广。

Objective： To evaluate the safety and efficacy of Glissonean pedicle transection method for anatomic mesohepatectomy. Methods： According to frequency-matching principle,51 patients with central liver tumors were randomly designated to undergo liver resection with conventional procedure（n=30） or Glissonean pedicle transection method（n=21）.The operative time,intraoperative blood loss,postoperative liver function,length of hospital stay,incidence of complications and outcomes between the two groups were compared. Results： By comparison with the conventional group,Glissonean pedicle transection group had decreased operative time [（2.7±0.839） h vs.（4.5±0.952） h],reduced intraoperative bleeding [（406±33.182） mL vs.（793±29.677） mL],fast recovery of liver function [ALT value on postoperative day（POD） 7：（63.048±7.513） U/L vs.（323.667±12.939） U/L],and shortened length of hospital stay [（12.528±0.245） d vs.（16.733±0.338） d],as well as lowered incidence of postoperative complications（14.2% vs.40%） and 1-year tumor recurrence rate [4.8%（1/21） vs.26.7%（8/30） ].All the differences between the two groups had statistical significance（all P0.05）. Conclusion： Glissonean pedicle transection method for anatomic mesohepatectomy is safe,effective,minimally invasive,and is recommended for general use.