Glisson鞘内鞘外联合血流阻断在腹腔镜肝右后叶切除术中的应用(附视频)

Application of Glissonian intra-sheath and extra-sheath blood flow occlusion in laparoscopic right posterior hepatectomy

目的探讨Glisson鞘内鞘外联合血流阻断在腹腔镜肝右后叶切除术中的安全性和应用价值。方法回顾性分析2015年7月至2017年7月在南昌大学第二附属医院行腹腔镜肝右后叶切除术的10例患者临床资料。患者均签署知情同意书,符合医学伦理规定。其中男3例,女7例;年龄37～62岁,中位年龄54岁。10例患者均行全腹腔镜下肝右后叶切除术,血流阻断方式均采用肝右后叶Glisson鞘内阻断联合肝右前叶鞘外间歇性阻断。观察术中、术后等围手术期情况。结果 10例患者均在全腹腔镜下完成肝右后叶切除术。肝右前叶Glisson鞘阻断中位阻断次数2(1～4)次,阻断时间(15±6)min;平均手术时间(246±96)min,术中出血量(384±95)ml,术中及术后均未输血。术后1周肝功能基本恢复正常,术后住院时间(9±4)d,引流管留置时间(5±2)d。术后无发生出血、胆漏、肝衰竭、腹腔感染等并发症。结论右侧Glisson鞘内鞘外联合血流阻断用于腹腔镜肝右后叶切除术是安全、可行的,具有创伤小、出血少、肝功能损伤小、恢复快的特点。

Objective To investigate the safety and application value of Glissonian intra-sheath and extra-sheath blood flow occlusion in laparoscopic right posterior hepatectomy. Methods Clinical data of 10 patients undergoing laparoscopic right posterior hepatectomy in the Second Affiliated Hospital of Nanchang University from July 2015 to July 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 3 cases were males and 7 females, aged 37-62 years, with a median age of 54 years. 10 cases underwent complete laparoscopic right posterior hepatectomy. Glissonian intra-sheath occlusion of the right posterior lobe and extra-sheath occlusion of the right anterior lobe were performed. The perioperative conditions were observed. Results All the 10 patients underwent laparoscopic right posterior hepatectomy successfully. The median frequency of Glisson occlusion of the right anterior lobe was 2（1-4） times, and the duration was （15±6） min. The average operative time was （246±96） min, and the intraoperative blood loss was （384±95） ml. No blood transfusion was performed during and after surgery. The liver function was almost restored at postoperative 1 week. The postoperative length of hospital stay was （9±4） d, the catheter indwelling time was （5±2） d. No bleeding, bile leakage, liver failure, abdominal infection and other complications occurred after surgery. Conclusions It is safe and feasible to perform Glissonian intra-sheath and extra-sheath blood flow occlusion in laparoscopic right posterior hepatectomy. It has the characteristics of smaller trauma, less blood loss, less liver damage and rapider recovery.