Glisson蒂横断联合循肝中静脉入路在腹腔镜下原发性肝癌左半肝切除术中的临床应用价值

Clinical Application Value of Glisson Pedicle Transsection Combined with Medium Hepatic Vein Approach in Laparoscopic Left Hemihepatectomy in Primary Liver Carcinoma Patients

目的探讨Glisson蒂横断联合循肝中静脉入路在腹腔镜下原发性肝癌左半肝切除术中的安全性及可行性。方法采用回顾性病例对照研究方法,选取2018年1月至2023年1月我院完成的68例行腹腔镜下原发性肝癌左半肝切除的患者,根据手术方式的不同分为观察组(30例,采用Glisson蒂横断联合循肝中静脉入路行腹腔镜左半肝切除术)和对照组(38例,采用传统Pringle法循肝中静脉入路行腹腔镜左半肝切除术)。比较两组患者的围术期情况、肝功能情况、肿瘤标志物水平、并发症发生率及远期生存率。结果两组患者均顺利完成手术,观察组术中肝血流阻断时间、术中出血量、离断肝实质时间均低于对照组,两组肝功能(TBIL、AST、ALT、ALB)及乳酸比较差异有统计学意义(P<0.05),观察组术后肿瘤复发转移率低于对照组(P<0.05)。结论Glisson蒂横断联合循肝中静脉入路在腹腔镜左半肝切除术应用安全可行,更符合腹腔镜解剖性肝切除的原则。

Objective To explore safety and feasibility of Glisson pedicle transsection combined with medium hepatic vein approach in laparoscopic left hemihepatectomy in primary liver carcinoma patients.Methods A retrospective case control study method was used,from January 2018 to January 2023,total 68 primary liver carcinoma patients admitted to our hospital were selected,and divided into observation group(OG,n=30,Glisson pedicle transsection combined with medium hepatic vein approach in laparoscopic left hemihepatectomy)and control group(CG,n=38,Pringle method combined with medium hepatic vein approach in laparoscopic left hemihepatectomy).Perioperative status,liver function,tumor marker,complication rates and long-term survival were compared.Results The operation was successfully completed.The time of intraoperative hepatic blood flow block,intraoperative blood loss and liver parenchyma in OG were lower than that of CG.liver function(TBIL,AST,ALT and ALB)and lactate were compared(P<0.05).The postoperative tumor recurrence and metastasis rate in OG was lower than that in CG(P<0.05).Conclusion Glisson pedicle transsection combined with medium hepatic vein approach would be safe and feasible in laparoscopic left hemihepatectomy,more in line with the principle of laparoscopic anatomical liver resection.