Laennec膜入路Glisson鞘外阻断联合ICG荧光影像在解剖性肝切除术中的应用(附视频)

Application of extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging in anatomic hepatectomy(video attached)

目的探讨Laennec膜入路Glisson鞘外阻断联合ICG荧光影像在解剖性肝切除术中的安全性和疗效。方法回顾性分析2022年1月至2022年10月湖南省吉首大学第一附属医院施行肝切除术的25例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男11例,女14例;年龄45~73岁,中位年龄50岁。术中沿Laennec膜间隙入路鞘外解剖Glisson蒂,使用弹力带悬吊阻断目标Glisson蒂;从外周静脉注射ICG利用荧光影像完成解剖性肝切除术。观察手术安全性和疗效。结果所有手术均顺利完成,无围手术期死亡。患者均采用Glisson鞘外区域肝蒂弹性阻断联合ICG荧光染色完成解剖性肝切除术,其中肝左外叶切除4例、左内叶切除1例、左半肝切除7例、右前叶切除2例、右后叶切除2例、右半肝切除3例、S2段切除1例、S3段切除2例、S3+S4段切除1例、S4+右前叶腹侧段切除1例、肝S6+S5d段切除1例。切除病肝的同时最大程度保留了剩余肝体积的组织功能,无一例医源性胆管血管损伤。手术时间中位数4.3(1.5~6.0)h,术中出血量80(20~600)ml。术后1周内肝功能均恢复正常,无术后出血及胆漏发生,均恢复顺利出院。结论Laennec膜入路Glisson鞘外阻断联合ICG荧光影像在解剖性肝切除术中应用安全、有效,为建立流程化、标准化的解剖性肝切除手术方式提供了新的思路。

Objective To evaluate the safety and efficacy of extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging in anatomic hepatectomy.Methods Clinical data of 25 patients undergoing hepatectomy in the First Affiliated Hospital of Jishou University from January 2022 to October 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,11 patients were male and14 female,aged from 45 to 73 years,with a median age of 50 years.Intraoperatively,Glisson's pedicle was dissected via the space of Laennec's capsule,and the transection of target Glisson's pedicle was achieved by suspension of elastic band.Anatomic hepatectomy was performed by peripheral intravenous injection of ICG using ICG fluorescence imaging.The safety and efficacy of this procedure were observed.Results All patients successfully completed the surgery without perioperative death.Anatomic hepatectomy was performed by extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging.Among them,4 patients underwent the left lateral lobe resection,1 case of the left inferior lobe resection,7 cases of left liver resection,2 cases of the right anterior lobe resection,2 cases of the right posterior lobe resection,3 cases of the right liver resection,1 case of S2 segment resection,2 cases of S3 segment resection,1 case of S3+S4 segment resection,1 case of S4+right anterior ventral segment resection,and 1 case ofS6+S5d segment resection,respectively.The tissue function of the remaining liver volume was preserved to the largest extent when the diseased liver was resected,and no iatrogenic bile duct vascular injury was reported.The median operation time was 4.3(1.5-6.0)h.Intraoperative blood loss was 80(20-600)ml.The liver function was restored to normal within postoperative 1 week,and no postoperative bleeding or bile leakage occurred.Conclusions Extrathecal transection of Glisson's pedicle via Laennec's capsule combined with ICG fluorescence imaging in anatomic hepatectomy is a safe and effective procedure in anatomic hepatectomy,which provides novel ideas for establishing a streamlined and standardized anatomic hepatectomy.