右肝蒂Glisson鞘外阻断在腹腔镜右半肝切除术中的应用初探

Application of Glisson extrasheath occlusion of right hepatic pedicle in laparoscopic right hemihepatectomy

目的探讨右肝蒂Glisson鞘外血流阻断在腹腔镜右半肝切除术中应用的安全性和近期疗效。方法回顾性分析2016年1月1日至2019年6月30日湖南省人民医院行腹腔镜右半肝切除术患者的临床资料。本组共71例,按血流阻断方式分为两组,A组采用右肝蒂Glisson鞘外血流阻断(n=30),B组采用Pringle血流阻断(n=41),比较两组病例手术时间、术中失血量、术后住院时间、近期并发症及围术期白细胞计数、肝功能等。结果两组均无围手术期死亡病例。两组手术时间、术中失血量、术后白蛋白和近期并发症发生率比较,差异无统计学意义(P>0.05);A组术后住院时间较B组短,差异有统计学意义(P<0.05);A组术后第1、3天白细胞低于B组,差异有统计学意义(P<0.05),但术后第7天两组白细胞无统计学差异(P>0.05);A组术后第1、3、7天ALT、AST、TBIL均低于B组,差异有统计学意义(P<0.05)。结论右肝蒂Glisson鞘外血流阻断在腹腔镜右半肝切除中的应用是安全、有效的,并且对患者术后肝功能影响更小、患者术后恢复更快。

Objective To investigate the safety and efficacy of Glisson vascular control and Pringle method in total laparoscopic right hemihepatectomy. Methods The data of patients who received total laparoscopic right hemihepatectomy from Jan. 1, 2016 to Jun. 30, 2019 in Hunan Provincial People’s Hospital were divided into two groups according to different hepatic blood flow occlusion: group A(n=30, Glisson extrasheath occlusion of right hepatic pedicle group), and group B(n=40, Pringle occlusion group). The operation time, intraoperative blood loss, hospitalization time, postoperative complications, white blood cells and liver function during perioperative period were observed. Results No perioperative death occurred in neither group. There was no significant difference in operation time, intraoperative blood loss, the level of ALB after operation, or postoperative complications between the two groups(P>0.05). The hospitalization time in group A was significantly shorter than that in group B(P<0.05). The levels of white blood cells in group A was significantly lower than those in group B on the 1 st and 3 rd day after operation(P<0.05), while there was no significant difference in white blood cells between the two groups on the 7 th day after operation(P>0.05).The levels of ALT, AST, and TBIL in group A were significantly lower than those in group B at the 1 st, 3 rd, and 7 th day after operation(P<0.05). Conclusion Glisson extrasheath occlusion of right hepatic pedicle is safe and effective in laparoscopic right hepatectomy and has less effect on patients’ liver function.