Glisson蒂横断技术在解剖性肝切除中的应用

The Application of Anatomic Hepatectomy with Glissonean Pedicle Transection Technique for Hepatic Resection

日的探讨Glisson蒂横断技术在解剖性肝切除中的应用价值。办法回顾性分析2010年6月-2012年12月期间采用Glisson蒂横断技术行解剖性肝切除术病人23例的临床资料，其中原发性肝癌13例，肝内胆管结石10例。采用G1isson蒂横断技术分别行左半肝切除8例、右半肝切除3例、肝右后叶（CouinaudⅥ，Ⅶ段）切除2例、肝Ⅵ段切除3例、肝Ⅱ段切除3例、肝Ⅲ段切除4例，观察其手术时间、术中出血量以及术后住院时间情况。结果本组病例均成功实施Glisson蒂横断技术行解剖性肝切除术，术中无Glisson鞘内血管或胆管的损伤。平均手术时间120（90-190）min；术中平均失血量400（150-850）ml；术后平均住院时间12．6（10-17）d。术后无严重手术并发症和死亡病例，均痊愈出院。结论Glisson蒂横断技术基于更为科学的临床肝脏解剖分段理念，能够有效地缩短手术时间，控制肝切除手术的术中出血量，有利于术后肝功能的恢复，操作技术简便、快速、安全，值得普遍推广应用。

Objective To evaluate the value of Glissonean pedicle transeetion technique in anatomical hepateetomy. Methods From June 2010 to December 2012,the clinical data of 23 patients underwent anatomical hcpatectomy using Glissonean pedicle transection technique in our deparlment were retrospectively analyzed,including 13 patients of hepatoearcinoma and 10 patients of hepatolithiasis. In the 23 patients,the operative procedures included the left hemihepateetomy（ n = 8） and the right hemihepatectomy（ n = 3）, the operative proce- dures included the right posterior hepatolobeetomy（ Couinaud Ⅵ, Ⅶ,n = 2） ,the segmenteetomy of Ⅵ（n = 3）, the segmentectomy of Ⅱ （n = 3） , the segmenteetomy of Ⅲ （n = 4）. The data of average operation time, mean blood loss and mean postoperative hospital stay was observed. Results All of the 23 patients were sueeessfully performed anatomical hepatectomy using Glissonean pedicle transeetion technique without injury of the blood vessels or biliary ducts during operation. The average operative time was 120（90 - 190） min,the mean blood loss was 440 （ 150 -800） ml, and the mean postoperative hospital stay was 12.6（ 10-17）days. As a result, the patients had no serious postoperative com- pliealions and were all cured. Conclusion Glissonean pedicle transection teehnique based on the reasonable three segments of liver anato- my,ean effectively shorten the operation time,reduce intraoperative blood loss,and relieve liver damage significantly. It shows that the Glisso- nean pediele transeetion technique for anatomical hepatectnmy is an easy,safe and prompt operation,which can be widely used in clinic.