不解剖GLISSON鞘区域血流阻断肝脏肿瘤切除

Clinical Application of“Without Anatomical Glisson Sheath”Regional Vascular Occlusion in Hepatectomy

目的:探讨不解剖Glisson鞘区域血流阻断肝脏肿瘤切除的临床应用价值。方法:回顾性分析哈尔滨医科大学附属第一医院普外科2000年6月-2013年6月对40例肝脏肿瘤患者施行的肝部分切除术的临床资料。将手术分为不解剖Glisson鞘区域血流阻断切肝组(A组)20例和第一肝门入肝血流阻断切肝组(B组)20例,比较两组术后的手术时间、术中出血量、术中输血量、术后肝功能的恢复、术后并发症以及住院时间等情况。结果:两组在手术时间方面存在明显差异。而其他指标,如术中出血量、术中输血量、术后肝功能的恢复、术后并发症以及住院时间等,A组也明显优于B组。结论:不解剖Glisson鞘区域血流阻断技术能够有效的控制术中出血,减轻肝脏缺血再灌注损伤,防止术中由门静脉介导的癌细胞肝内扩散,是一种合理的血流阻断方法。

Objective： To explore the value of clinical application of ＂without anatomical Glisson sheath＂regional vascular occlusion in hepatectomy. Methods： This is a retrospective study on the clinical data of 40 patients who underwent segmentectomy at the General Surgery Department of First Affiliated Hospital of Harbin Medical University from 2000 to 2013. Among the 40 patients, 20cases（Group A）were performed ＂without anatomical Glisson sheath＂regional vascular occlusion, the rest（Group B） were performed continuous hepatic vascular occlusion. The operative duration, the intraoperative blood loss, the blood transfusion, the postoperative complications, the postoperative liver function recovery and the length of hospital stay were compared between two groups. Results： In both groups, there was a significant difference in operative duration. The intraoperative blood loss, the blood transfusion, the postoperative liver function recovery as well as the length of hospital stay in Group A were significantly superior to that in Group B.Conclusions： It is ＂without anatomical Glisson sheath＂regional vascular occlusion that is an effective and feasible method that can notably control the amount of blood loss, decrease the residual liver ischemia-reperfusion injury as well as prevent the spread of liver cancer mediated by the portal vein.