Glisson蒂横断法在腹腔镜左肝段切除术中的应用

Application of Glisson pedicle transection method in laparoscopic resection of left liver segments

目的:探讨应用Glisson蒂横断法行腹腔镜左肝段切除术的可行性及技术要点。方法:回顾分析2015年1月至2016年10月为14例患者行腹腔镜下Glisson蒂横断法左肝段切除术的临床资料。观察手术时间、术中出血量、住院时间、术后并发症、近期及远期疗效等指标。结果:14例患者均成功施行腹腔镜下Glisson蒂横断法左肝段切除术,无一例中转开腹,其中肝左外叶切除5例、左半肝切除4例,Ⅱ、Ⅲ段肝切除各2例,Ⅳ段肝切除1例。手术时间100~240 min,平均(140.6±89.3)min;术中出血量150~300 ml,平均(200.5±95.7)ml;住院5~10 d,平均(7.8±2.4)d;无手术并发症发生,随访早期无肿瘤复发与转移。结论:腹腔镜下Glisson蒂横断法左肝段切除术的优势在于迅速、精确的到达Glisson蒂左肝段分支,适于左半肝、左外叶及Ⅱ、Ⅲ、Ⅳ段的肝肿瘤,手术安全、可行,可在很大程度上简化腹腔镜肝段切除术。

Objective：To explore the feasibility and technical essential of Glisson pedicle transection method in laparoscopic resection of left liver segments. Methods： Between Jan. 2015 and Oct. 2016,14 patients underwent laparoscopic resection of left liver segments with Glisson pediele transection method. Clinical data was recorded to observe operation time,intraoperative blood loss,hospi- tal stay, postoperative complications, short and long term survival outcomes. Results： All 14 patients underwent laparoseopic resection of left liver segments using the Glisson pedicle transection method successfully, without conversion to laparotomy. There were 5 cases of he- patic left lateral lobectomy,4 cases of left hemihepatectomy,2 cases of individual resections of segment II or III respectively, 1 case of IV. The average operation time was （ 140.6 ± 89.3 ） rain （ range, 100-240 min）. The average blood loss during operation was （200.5 ± 95.7） ml （range,150-300 ml）. The average hospital stay after operation was （7.8 ±2.4） d （range,5-10 d）. No complications oc- curred after operation. During the follow-up, no tumor recurrence or metastasis occurred. Conclusions ： The main advantage of this meth- od is the possibility of gaining a rapid and precise access to the left Glisson pedicle, facilitation of left hemihepatectomy, bisegmentecto- my II-III, and individual resections of segments II , III and IV. The Glisson pedicle transection method in laparoscopic resection of left liver segments is feasible and safe, this method can simplify the procedure of laparoscopic segmental hepatectomy.