Glisson蒂阻断式肝切除术33例报道

2016-08-06张国平牟廷刚内江市第一人民医院肝胆胰外科四川内江641000

中国医药指南 2016年18期

赖良张国平谢飞向鑫徐波牟廷刚（内江市第一人民医院肝胆胰外科，四川内江 641000）

赖良张国平谢飞向鑫徐波牟廷刚
（内江市第一人民医院肝胆胰外科，四川内江 641000）

目的探讨“Glisson蒂阻断式肝切除术”的实用性和安全性。方法将69例符合标准的原发性肝癌随机分为两组，治疗组“Glisson蒂阻断式肝切除术”33例，对照组传统肝切除术Pringle阻断法36例，比较两种手术方法的术中出血量、术后肝功能指标。结果治疗组顺利完成手术，两组手术时间相比差异无统计学意义。术中出血量，治疗组（180±14.2）mL，对照组（420±34.3）mL，差异有统计学意义（P＜0.01）；术后第1天、3天、7天肝功能检测数据ALT值及AST值，治疗组优于对照组，差异有统计学意义（P＜0.01）。结论 “Glisson蒂阻断式肝切除术”可减少术中出血、保护肝功能，减少手术并发症，是适用的，是安全有效的。

肝切除术；蒂横断；Glisson蒂

［Abstract］Objective To evaluate the utility and safety in patients undergoing hemihepatectomy. Methods 69 cases undergoing hemihepatectomy were divided into two groups. The treatment group （n=33） and Pringle's maneuver control group （n=36）. The amount of intraoperative bleeding， operation time， postoperative liver function and liver function recovery were compared between the two groups. Results The Pringle's maneuver group have 1 cases of vascular injury. There were no difference in the time of operation between the two groups. There was a difference in the amount of mean intraoperative blood loss between the two groups. Liver function recovery measured on postoperative was better in The treatment group than that in Pringle's group. There was a difference in the value of serum AFP on postoperative between the two groups. Conclusion The method of both of Glisson pedicle transection liver resection and secondary branches suspension is useful for hemihepatectomy.

［Key words］Hepatectomy； Pedicle transection； Glisson pedicle

肝切除术中大出血及术后严重肝功能损害是危及患者生命的严重并发症。目前切肝的方式多种多样，而怎样提高手术切除率，尽量减少术中出血，尽量保护肝功能，减少手术并发症是肝脏外科医师追求的目标。Glisson蒂横断式肝切除术是日本Takasaki教授首先报道的［1-2］，该术式因阻断方便完整、对病肝骚扰小而得到认可.但国内仅见这一术式的零星报道，但缺乏详细资料，2009年以来我们采用“Glisson蒂横断式肝切除术”在肝占位性病变手术中进行了初步实践，报道如下。