Glisson蒂鞘外法和鞘内法在腹腔镜肝细胞癌切除术中的倾向性评分匹配研究

Extrathecal vs. intrathecal approach of Glisson's pedicle in laparoscopic resection of hepatocellular carcinoma: a propensity score matched analysis

目的比较Glisson蒂鞘外法和鞘内法在腹腔镜肝细胞癌(HCC)切除术中运用效果差异。方法回顾性分析2019年1月至2022年6月联勤保障部队第九OO医院肝胆外科行腹腔镜肝切除术的96例HCC患者的临床资料。其中, 鞘外法处理Glisson蒂(鞘外组)36例, 鞘内法处理Glisson蒂(鞘内组)60例, 对患者一般资料进行1∶1倾向性评分匹配, 卡钳值取0.02。对比两组患者手术时长、第一肝门阻断时长、术中出血量、术后第1天肝功能指标、凝血酶原时间, 术后并发症发生情况, 术后住院时间, 术后生存、复发情况。结果两组各32例匹配成功, 匹配后鞘外组手术时间短于鞘内组[(207.5±77.4)min比(248.6±74.7)min, P=0.03]、术中出血量少于鞘内组[150.0(100.0, 300.0)ml比250.0(150.0, 587.5)ml, P=0.01]、术后第1天白蛋白水平高于鞘内组[(36.5±3.2)g/L比(34.3±3.2)g/L, P<0.01], 差异均有统计学意义。两组术后肝功能、凝血功能、术后并发症、住院时间、术后生存率及无瘤生存率差异均无统计学意义(均P>0.05)。结论 Glisson蒂鞘外法在腹腔镜HCC切除术中安全可行, 可以简化手术操作、减少术中创伤。

Objective To evaluate extrathecal vs.intrathecal approach of Glisson's pedicle in laparoscopic hepatectomy of hepatocellular carcinoma(HCC).Methods Clinical data of 96 HCC patients receiving laparoscopic hepatectomy at the Department of Hepatobiliary Surgery,the 900 Hospital of the United Logistics Force from Jan 2019 to Jun 2022 were retrospectively analyzed.Thrity-six cases were treated with extrathecal approach of Glisson's pedicle and 60 cases were by intrathecal approach.All those 60 undergoing intrathecal approach cases were matched by 1∶1 propensity score matching,and the caliper value was 0.02.The duration of surgery,blocking-time of hepatoduodenal ligament,intraoperative blood loss,indexes of the liver function and the prothrombin time on the 1st day of the postoperative period,rate of the postoperative complications,postoperative hospital stay,postoperative survival and recurrence were compared between the two groups.Results After propensity score matching,32 cases in each group were identified.The operation time of the extrathecal group was shorter than that of the intrathecal group[(207.5±77.4)minutes vs.(248.6±74.7)minutes,P=0.03],the intraoperative bleeding volume was less than that of the intrathecal group[(150.0(100.0,300.0)ml vs.250.0(150.0,587.5)ml,P=0.01],and the albumin level was higher on the 1st day after the surgery[(36.5±3.2)g/L vs.(34.3±3.2)g/L,P<0.01].There was no statistically significant difference in postoperative liver function,coagulation,complications,hospitalization time,all over survival rate between the two groups(all P>0.05).Conclusion Extrathecal approach for Glisson's pedicle is safe and feasible in laparoscopic hepatectomy for HCC,with simpler surgical procedure,less intraoperative trauma.