区域肝蒂阻断技术在肝脏精准切除术中的运用

Application of regional Glisson pedicle occlusion for accurate hepatectomy

目的探讨精准肝脏切除术中运用区域肝蒂阻断技术的临床价值。方法回顾性分析2014年1月至2017年5月苏州大学附属第一医院58例采用肝蒂横断式技术行肝脏切除术的患者资料。其中解剖性肝段切除46例,占全部手术的79%(46/58),非解剖性肝切除12例;包括左外叶切除(II+III段)11例,左半肝切除(II+III+IV段)4例,右前叶切除(V+VIII段)1例,右后叶切除(VI+VII段)10例,右半肝切除(V+VI+VII+VIII段)14例,中肝切除(IV+V+VIII段)6例,局部切除12例。结果全组均顺利完成手术,平均手术时间240(80～430)min,平均失血量420(50～800)mL,术后并发胆瘘2例,腹腔出血1例,均保守治疗后好转。结论区域肝蒂血流阻断技术能最大限度地减少肝脏热缺血再灌注损伤,保护残余肝功能,有利于术后患者肝脏功能的恢复,具有良好的临床应用前景。

Objective To evaluate the value of regional Glisson pedicle occlusion in accurate hepatectomy.Methods The clinical data of 58 patients who underwent hepatectomy with Glisson pedicle occlusion in the First Affiliated Hospital of Soochow University was retrospectively analyzed. Among them, 46 cases underwent anatomical hepatectomy, others underwent non-anatomical hepatectomy. The surgical methods included left lateral hepatolobectomy(Couinaud II+III) in 11 cases, left hemihepatectomy(Couinaud II+III+IV) in 4 cases,right anterior hepatolobectomy(Couinaud V+VIII) in 1 case, the right posterior hepatolobectomy(Couinaud VI+VII) in 10 cases, right hemihepatectomy(Couinaud V+VI+VII+VIII) in 14 cases, middle hepatolobectomy(IV+V+VIII) in 6 cases and local hepatectomy in 14 cases. Results All 58 cases were completed operation.The average operative time was 240(80~430) min, the mean blood loss was 420(50~800) m L, and 2 patients suffered from bile leakage and 1 patients suffered from hemorrhage, all patients improved after conservative treatment. Conclusion Regional Glisson pedicle occlusion can reduce the warm ischemia-reperfusion injury in the hepatectomy and protect the function of liver, which can be widely used in the clinic.