腹腔镜下经Glisson蒂鞘外横断式解剖性肝切除术在临床中的应用

Clinical Application of Laparoscopic Glissonean Sheath-transection Liver Resections

目的探讨腹腔镜下经Glisson蒂鞘外横断式解剖性肝切除术的可行性及技术要点。方法收集2019年3月至2021年12月宁夏医科大学总医院肝胆外科收治的40例行肝切除术的患者,16例在全腹腔镜下行鞘外Glisson蒂横断式解剖性肝切除术(腹腔镜组),24例行传统开腹肝切除术(开腹组),比较两组患者术中及术后临床指标及并发症发生情况。结果两组患者均顺利完成手术,腹腔镜组顺利完成全腹腔镜下鞘外Glisson蒂横断式解剖性肝切除,其中左半肝切除2例、左外叶切除9例、右前叶S5段切除2例、右后叶S6段切除2例、右后叶S7段1例,无中转开腹,患者未发生术后肝脏断面出血等并发症。腹腔镜组除手术时间比开腹组长(P<0.05),出血量、输注红细胞、血浆量、腹腔引流管拔除的时间、住院时间等差异均无统计学意义(P均>0.05)。腹腔镜组术后胃肠减压管拔除时间及术后进食时间均短于开腹组(P均<0.05),两组患者术后并发症差异无统计学意义(P>0.05)。结论全腹腔镜下鞘外Glisson蒂横断式肝切除术可安全、有效控制腹腔镜下肝切除时术中的出血,快速解决边界难以确定及切除范围等问题,推荐用于腹腔镜下肝脏疾病解剖性肝切除术。

Objective To explore the feasibility and technical points of total laparoscopic extrathecal Glissonpedicle transection anatomical hepatectomy.Methods 40 patients after liver resections in the Department of Hepatobiliary Surgery of the General Hospital of Ningxia Medical University from Mar.2019 to Dec.2021 were divided into 2 groups,including open surgery group with 24 cases using traditional operation technology and laparoscopic group with 16 cases using laparoscopic.The intraoperative and postoperative clinical indexes and complications of the two groups were compared.Results Both groups of patients successfully completed surgery,and the laparoscopic group successfully completed the total laparoscopic Glisson transection anatomical liver resection,including segment left hemihepatectomy in 2 cases,left external lobe resection in 9 cases,segment S5 in 2 cases,segment S6 in 2 cases,segment S7 in 1 case,there were no cases of conversion to laparotomy,and no complications such as postoperative hemorrhage in the liver section.The laparoscopic group had no significant differences in bleeding volume,red blood cell infusion,plasma volume,abdominal drainage tube removal time,and hospital stay compared to open liver resection(P all>0.05),except for the longer surgical time(P all<0.05).The removal time of the gastrointestinal decompression tube and postoperative feeding time in the laparoscopic group were shorter than those in the open group(P all<0.05),and there were no significant difference in postoperative complications between the two groups of patients(P>0.05).Conclusion Laparoscopic extrasheath Glisson pedicle transverse hepatectomy can safely and effectively control intraoperative bleeding during laparoscopic hepatectomy,quickly solve problems such as difficult boundary determination and resection range,and is recommended for laparoscopic anatomical hepatectomy for liver diseases.