完全腹腔镜下肝外Glisson鞘内解剖性肝切除术

Application of Complete Laparoscopic Extrahepatic Glisson Intrathecal Anatomic Hepatectomy

目的探讨肝外Glisson鞘内解剖选择性阻断入肝血流在完全腹腔镜解剖性肝切除术中的应用价值。方法回顾性分析2018年1月~2019年7月34例完全腹腔镜下解剖性肝切除的临床资料。于肝外解剖Glisson鞘,鞘内解剖出肝动脉及门静脉,预先阻断预切除肝脏入肝血流。结果均在腔镜下完成手术,行右半肝切除12例,左半肝切除12例,右后叶切除3例,左肝外侧叶切除7例,无中转开腹。手术时间(2.7±0.6)h,术中出血量(414.7±194.0)ml,9例(26.5%)输血,术后常规不留置胃管,肛门排气时间(3.3±0.6)d,术后住院时间(8.2±3.4)d,无死亡。并发症包括腹水2例,肺部感染1例。34例随访时间1~18个月,平均8.8月,无肿瘤及结石复发。结论肝外Glisson鞘内解剖选择性阻断入肝血流操作相对简单、安全,可常规应用于完全腹腔镜下解剖性肝切除。

Objective To investigate surgical focus and clinical outcome of extrahepatic Glisson intrathecal anatomy to selectively block hepatic blood flow in complete laparoscopic anatomic hepatectomy.Methods The clinical data of 34 patients undergoing complete laparoscopic anatomic hepatectomy in our hospital from January 2018 to July 2019 were retrospectively analyzed.The Glisson sheath was dissected outside the liver,and hepatic arteries and portal veins were dissected in the sheath to block the hepatic blood flow of pre-resection liver.Results The laparoscopic surgery was accomplished without conversion to open surgery.There were 12 cases of laparoscopic right hepatectomy,12 cases of left hepatectomy,3 cases of right posterior resection,and 7 cases of left hepatic lateral resection.The mean operative time was(2.7±0.6)h,and the mean blood loss in operation was(414.7±194.0)ml.Nine patients(26.5%)needed blood transfusion during operation.The gastric tube was not indwelt routinely.Postoperative average anal exhaust time was(3.3±0.6)d,and average postoperative hospital stay was(8.2±3.4)d.There was no fatal case.There were 2 cases of ascites and 1 case of pulmonary infection.All the 34 patients were followed up for 1-18 months(mean,8.8 months).No tumor or stone recurrence was seen.Conclusion Extrahepatic Glisson intrathecal anatomy for selective blocking the hepatic blood flow is safe and effective,and can be routinely applied in complete laparoscopic anatomical hepatectomy.