肝门板分离技术在腹腔镜解剖性肝右叶切除中的应用价值

Value of hilar plate detachment in laparoscopic anatomic right hepatectomy

目的探讨肝门板分离技术在腹腔镜解剖性肝右叶切除中的应用价值。方法回顾性分析2016年7月至2019年10月在佛山市第一人民医院行腹腔镜解剖性肝右叶切除术的28例肝细胞癌(肝癌)患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男22例,女6例;年龄25~71岁,中位年龄59岁。术中均采用肝门板分离技术行Glisson鞘外入肝血流阻断。观察患者围手术期情况,包括手术时间,术中出血量,术后住院时间,术后1、3、7 d肝功能,术后并发症等。结果所有患者均顺利完成腹腔镜解剖性肝右叶切除术,无中转开腹,无围手术期死亡。其中包括右半肝切除16例,肝右前叶切除3例,肝右后叶切除9例。术中出血量中位数425(300~775)ml,平均手术时间(358±72)min,术后住院时间(11±3)d。患者无术后出血及切口感染。术后发生右侧胸腔少量积液21例,保守治疗后治愈。胆漏1例,经通畅引流后治愈。术后7 d患者肝功能基本恢复正常。结论肝门板分离技术在腹腔镜解剖性肝右叶切除治疗肝癌中应用安全、可行,其简化了手术流程,对肝蒂进行预阻断可指导精准解剖性肝右叶切除。

Objective To investigate the value of hilar plate detachment in laparoscopic anatomic right hepatectomy.Methods Clinical data of 28 patients with HCC who underwent laparoscopic anatomic right hepatectomy from July 2016 to October 2019 in the First People's Hospital of Foshan were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,22 patients were male and 6 female,aged 25-71 years and with a median of 59 years.Inflow blood occlusion via extra-Glissonean approach was performed with hilar plate detachment during the operation.Perioperative conditions,including duration of operation,intraoperative bleeding,postoperative hospital stay,postoperative 1,3,7 d liver function,and postoperative complications,were observed.Results All patients underwent successful laparoscopic anatomic right hepatectomy without conversion to open surgery and no perioperative death occurred.There were 16 cases of right hepatectomy,3 cases of right anterior lobe resection and 9 cases of right posterior lobe resection.The median intraoperative bleeding was 425(300-775)ml,the mean duration of operation was(358±72)min,and postoperative hospital stay was(11±3)d.No postoperative bleeding or incision infection was observed.21 cases suffered from mild right-sided pleural effusion,and recovered after conservative treatments.1 case suffered from bile leakage and recovered by unobstructed drainage.On postoperative 7 d,the patient's liver function returned to normal basically.Conclusions Hilar plate detachment in laparoscopic anatomic right hepatectomy is safe and feasible,which can simplify the operative procedures.Pre-occlusion of blood flow at the hepatic pedicle can provide guidance for precise anatomic right hepatectomy.