简易选择性鞘外入肝血流阻断法在腹腔镜左半肝切除术中的应用

Application of simple selective Glisson’s extracapsular blood flow occlusion in laparoscopic left hemihepatectomy

目的探讨简易选择性鞘外入肝血流阻断方法在腹腔镜左半肝切除术应用中的安全性和可行性。方法回顾性分析2016年1月15日至2021年8月15日梅州市人民医院45例因左肝肿瘤行腹腔镜左半肝切除术患者的临床资料。按入肝血流阻断方式分为两组,A组采用简易选择性鞘外入肝血流阻断方法阻断(n=21),B组采用左肝Glisson蒂鞘内分离结扎方法阻断(n=24),比较两组病例手术时间、术中出血量、术后住院时间、近期并发症及围手术期血白细胞数、肝功能等资料。结果两组病例手术时间、术中出血量、术后住院时间、近期并发症发生率和术后白蛋白、胆红素、凝血酶原时间比较,差异无统计学意义(P>0.05)。A组术后第1、3天白细胞数及术后第1天ALT、术后第3天AST均低于B组,差异有统计学意义(P<0.05)。结论简易选择性鞘外入肝血流阻断方法在腹腔镜左半肝切除术操作简便、安全可行,值得临床上推广使用。

Objective To investigate the safety and feasibility of simple selective Glisson’s extracapsular blood flow occlusion in laparoscopic left hemihepatectomy.Methods Clinical data of 45 patients with liver tumor who underwent laparoscopic left hemihepatectomy in Meizhou People’s Hospital from Jan.15,2016 to Aug.15,2021 were retrospectively analyzed.They were divided into two groups:group A received Glisson’s extracapsular blood flow occlusion(n=21)and group B underwent Glisson’s intracapsular blood flow occlusion(n=24).The two groups were compared in terms of the operation time,intraoperative blood loss,postoperative hospital stay,short-term complications,perioperative leukocyte count and liver function.Results There were no deaths in the two groups during the perioperative period.There was no significant difference between the two groups in terms of operation time,intraoperative blood loss,postoperative hospital stay,incidence of short-term complications,postoperative albumin,bilirubin and prothrombin time(P>0.05).The number of white blood cells in group A was significantly lower compared to group B on the 1st and 3rd day after operation(P<0.05).The level of ALT on the first day and AST on the 3rd day in group A were lower than that in group B(P<0.05).Conclusion Simple selective Glisson’s extracapsular blood flow occlusion is safe and feasible in laparoscopic left hemihepatectomy for liver tumor,which is worthy of clinical application.