Glisson蒂横断式肝切除术治疗肝细胞癌

Hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma

目的探讨Glisson蒂横断式肝切除术在治疗肝细胞癌(肝癌)中的应用价值。方法回顾性分析2002年1月至2012年12月在西安交通大学医学院第一附属医院行根治性肝切除术的54例肝癌患者临床资料。根据手术方法将患者分为Glisson蒂横断式肝切除术组(Glisson组)和Pringle法肝切除术组(Pringle组),每组27例。所有患者均签署知情同意书,符合医学伦理学规定。Glisson组采用游离、阻断Glisson蒂后行肝切除术,Pringle组采用Pringle法阻断第一肝门后行肝切除术。观察两组术中情况、术后肝功能变化及并发症发生情况。术后患者接受随访,并进行生存分析。两组计量资料比较采用t检验,率的比较采用χ2检验或Fisher确切概率法。生存分析采用Kaplan-Meier法和Log-rank检验。结果 Glisson组术中平均出血量为(135±57)ml,明显少于Pringle组的(248±87)ml(t=-5.62,P<0.05)。Glisson组患者术后1 d的TB为(23±5)μmol/L,明显低于Pringle组的(34±5)μmol/L(t=-8.08,P<0.05)。Glisson组术后发生出血2例、感染2例,Pringle组术后发生出血3例、感染1例、胆漏1例,两组术后并发症发生率比较差异无统计学意义(P>0.05)。Glisson组患者1、3、5年累积生存率分别为89%、50%、39%,Pringle组相应为82%、55%、41%;Glisson组患者1、3、5年无瘤生存率分别为89%、43%、34%,Pringle组相应为82%、47%、41%。两组累积生存率及无瘤生存率比较差异均无统计学意义(χ2=0.001,0.011;P>0.05)。结论 Glisson蒂横断式肝切除术具有出血量少、肝损伤轻等优点,是治疗肝癌的安全、有效、可行的手术方法。

Objective To investigate the application value of hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma （HCC）. Methods Clinical data of 54 patients with HCC undergoing radical hepatectomy in the First Affiliated Hospital of Medical College, Xi’an Jiaotong University from January 2002 to December 2012 were analyzed retrospectively. According to different surgical procedure, the patients were divided into hepatectomy with Glissonean pedicle transection group （Glisson group） and hepatectomy with Pringle maneuver （Pringle group） with 27 cases in each group. The informed consents of all patients were obtained and the ethical committee approval was received. In Glisson group, hepatectomy was performed after Glissonean pedicles were dissected and occluded. In Pringle group, hepatectomy was performed after the ifrst porta was occluded using Pringle maneuver. The intraoperative situation, the variation＆amp;nbsp;of liver function and incidence of complications after operation of two groups were observed. The patients received follow-up after operation and survival analysis was conducted. The comparison of measurement data between two groups was conducted using t test, the comparison of rates using Chi-square test or Fisher＆#39;s exact probability test, and the survival analysis using Kaplan-Meier method and Log-rank test. Results The mean of intraoperative blood loss in Glisson group [（135±57） ml] was signiifcantly less than that in Pringle group[（248±87） ml] （t=-5.62, P〈0.05）. The total bilirubin （TB） level 1 d after operation in Glisson group [（23±5） μmol/L] was significantly lower than that in Pringle group [（34±5） μmol/L] （t=-8.08, P＆lt;0.05）. In Glisson group, postoperative hemorrhage was observed in 2 cases and infection in 2 cases. In Pringle group, postoperative hemorrhage was observed in 3 cases, infection in 1 case, and bile leakage in 1 case. No signiifcant difference was observed in the incidence of postoperative complications between two groups （P〉0.05）. The 1-, 3-, 5-year cumulative survival rates were 89%, 50%, 39%in Glisson group and were 82%, 55%, 41%in Pringle group. The 1-, 3-, 5-year disease-free survival rates were 89%, 43%, 34%in Glisson group and were 82%, 47%, 41%in Pringle group. No signiifcant difference was observed in the cumulative survival rates and disease free survival rates between two groups （χ2=0.001, 0.011; P＆gt;0.05）. Conclusion Hepatectomy using Glissonean pedicle transection is a safe, effective, and feasible surgical procedure for HCC with advantages of less blood loss, milder liver damage.