Glisson蒂横断式解剖性肝切除120例治疗体会
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摘要
目的探讨Glisson蒂横断式解剖性肝切除术的应用价值。方法回顾性分析临沧市人民医院2014年1月至2017年3月行Glisson蒂横断式解剖性肝段切除术120例患者的临床资料。其中原发性肝癌65例,胆管细胞癌4例,肝门部胆管癌4例,胆囊癌6例,肝内胆管结石33例,肝血管瘤8例,肝寄生虫病10例。采用Glisson蒂横断式解剖性肝切除Ⅰ段切除3例,Ⅰ+Ⅱ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ段切除1例,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅳ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段切除1例,左外叶(Ⅱ+Ⅲ段)切除33例,左半肝(Ⅱ+Ⅲ+Ⅳ段)切除22例,左三叶(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段)切除3例,Ⅳb+Ⅴ段切除6例,Ⅳ+Ⅴ+Ⅷ段切除3例,右半肝切除(Ⅴ+Ⅵ+Ⅶ+Ⅷ段)25例,右三叶切除(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段)3例,右前叶(Ⅴ+Ⅷ段)切除5例,Ⅵ段切除2例,右后叶切除术(Ⅵ+Ⅶ段)4例,Ⅶ段切除2例,Ⅷ段切除4例。其中9例同时行肝管空肠RouxY吻合术。结果全组均完成手术。术中平均出血量630 mL。平均手术时间3.7 h。术后发生并发症34例(28.33%),为胆漏、胸腔积液、多重耐药菌感染等。结论 Glisson蒂横断式解剖性肝切除术操作简便,快速安全,能明显减少出血,提高疗效,是一种可选择的手术方式。
objective To investigate the application value of Glisson pedicle transection anatomical liver resection.Methods Retrospective analysis was conducted in 120 patients undergone Glisson pedicle transection anatomical liver resection in the People's Hospital of Lincang from Jan.2014 to Mar.2017.Among 120 patients,there were 65 cases of primary liver cancer,cholangiocarcinoma in 4 cases,hilar cholangiocarcinoma in 4 cases,gallbladder carcinoma in 6 cases,intrahepatic bile duct stone in 33 cases,hepatic hemangioma in 8 cases,and hepatic parasitic disease in 10 cases.I segment was resected in 3 cases,1+Ⅱ segment resection in 1 case,1+Ⅱ+Ⅲ+Ⅳ segment resection in 1 case,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ segment resection in 1 case,Ⅱ+Ⅲ+Ⅵ+Ⅷ segment resection in 1 case,left lateral lobe(Ⅱ+Ⅲ) resection in 33 cases,left half liver(Ⅱ+Ⅲ+Ⅳ) resection in 22 cases,left clover(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ) resection in 3 cases,Ⅳb+V segment resection in 6 cases,Ⅳ+Ⅴ+Ⅷ segment resection in 3 cases,right hepatectomy(Ⅴ+Ⅵ+Ⅶ+Ⅷ) in 25 cases,right trilobectomy(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ) in 3 cases,right anterior lobe(Ⅴ+Ⅷ) resection in 5 cases,Ⅵ segment resection in 2 cases,right after lobectomy(Ⅵ+Ⅶ) in 4 cases,Ⅶ segment resection in 2 cases,Ⅷ resection in 4 cases.Nine cases were treated with simultaneous Roux-Y surgery.Results All 120 cases were completed operation,The average intraoperative blood loss was 630 mL and the mean operative duration was 3.7 h.Postoperative complications occurred in 34 cases(28.33%),including bile leakage,pleural effusion and multiple drug resistance bacteria infection.Conclusion Glisson pedicle transection anatomical liver resection is simple,fast and safe,which can significantly reduce bleeding,improve the curative effect.This is an alternative surgical approach.
objective To investigate the application value of Glisson pedicle transection anatomical liver resection.Methods Retrospective analysis was conducted in 120 patients undergone Glisson pedicle transection anatomical liver resection in the People's Hospital of Lincang from Jan.2014 to Mar.2017.Among 120 patients,there were 65 cases of primary liver cancer,cholangiocarcinoma in 4 cases,hilar cholangiocarcinoma in 4 cases,gallbladder carcinoma in 6 cases,intrahepatic bile duct stone in 33 cases,hepatic hemangioma in 8 cases,and hepatic parasitic disease in 10 cases.I segment was resected in 3 cases,1+Ⅱ segment resection in 1 case,1+Ⅱ+Ⅲ+Ⅳ segment resection in 1 case,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ segment resection in 1 case,Ⅱ+Ⅲ+Ⅵ+Ⅷ segment resection in 1 case,left lateral lobe(Ⅱ+Ⅲ) resection in 33 cases,left half liver(Ⅱ+Ⅲ+Ⅳ) resection in 22 cases,left clover(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ) resection in 3 cases,Ⅳb+V segment resection in 6 cases,Ⅳ+Ⅴ+Ⅷ segment resection in 3 cases,right hepatectomy(Ⅴ+Ⅵ+Ⅶ+Ⅷ) in 25 cases,right trilobectomy(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ) in 3 cases,right anterior lobe(Ⅴ+Ⅷ) resection in 5 cases,Ⅵ segment resection in 2 cases,right after lobectomy(Ⅵ+Ⅶ) in 4 cases,Ⅶ segment resection in 2 cases,Ⅷ resection in 4 cases.Nine cases were treated with simultaneous Roux-Y surgery.Results All 120 cases were completed operation,The average intraoperative blood loss was 630 mL and the mean operative duration was 3.7 h.Postoperative complications occurred in 34 cases(28.33%),including bile leakage,pleural effusion and multiple drug resistance bacteria infection.Conclusion Glisson pedicle transection anatomical liver resection is simple,fast and safe,which can significantly reduce bleeding,improve the curative effect.This is an alternative surgical approach.
引文
[1]喻晓,孙振纲,王光链,等.Glisson蒂横断解剖性肝段切除86例临床分析[J].长江大学学报(自科版),2015,12(12):18-19.
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[11]张雅敏.解剖性肝切除在肝癌治疗中临床价值的再认识[J].临床肝胆病杂志,2016,32(8):1471-1476.
[12]吴宝强,江勇,朱峰,等.Glisson蒂横断式肝切除在解剖性肝切术中的应用[J].肝胆胰外科杂志,2013,25(3):185-187.
[13]杨小华,张伟刚,秦磊,等.Glisson蒂横断联合肝静脉阻断在肝切除术中的应用[J].肝胆胰外科杂志,2014,26(4):272-274.
[14]梁英健,刘连新.肝癌解剖性切除技术要点[J].中国实用外科杂志,2014,34(8):790-792.
[15]黄锦龙,王清,于勇,等.解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2015,36(5):492-499.
[16]荚卫东.精准肝脏外科时代肝癌多学科治疗[J].实用肝脏病杂志,2015,18(2):120-123.
[2]WU Z,GUO K,SUN H,et al.Caution for diagnosis and surgical treatment of recurrent cholangitis:lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor[J].Medicine(Baltimore),2014,93(11):e80.
[3]Takasaki K著,吕毅、李宗芳主译.Glisson蒂横断式肝切除术[M].北京:人民卫生出版社,2008:23-76.
[4]高绪照,唐瑞,熊廷刚,等.Glisson蒂阻断在肝切除术的应用[J].肝胆外科杂志,2016,24(2):57-58.
[5]王坚.复杂肝内胆管结石的诊断与处理[J].中国实用外科杂志,2016,36(3):292-295.
[6]涂奎,赵礼金,顾进,等.复杂肝胆管结石病的外科手术治疗58例[J].世界华人消化杂志,2014,22(26):3999-4002.
[7]罗翠松,林云,曾志峰,等.倾向值匹配法评价解剖性肝切除和非解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2016,37(12):1568-1572.
[8]王甸北,赵礼金,涂奎.解剖性肝切除术治疗肝内胆管结石的效果观察[J].临床肝胆病杂志,2017,33(1):102-105.
[9]MASATOSHI K.The 6th Asia-Pacific Primary Liver Cancer Expert Meeting(APPLE 2015):Evidence and Consensus on HCC Management[J].Liver Cancer,2015,4(Suppl 1):1-257.
[10]孙逊,许戈良,荚卫东,等.3D虚拟手术规划系统在精准肝切除治疗肝细胞癌的临床应用[J].国际外科学杂志,2014,41(8):537-540.
[11]张雅敏.解剖性肝切除在肝癌治疗中临床价值的再认识[J].临床肝胆病杂志,2016,32(8):1471-1476.
[12]吴宝强,江勇,朱峰,等.Glisson蒂横断式肝切除在解剖性肝切术中的应用[J].肝胆胰外科杂志,2013,25(3):185-187.
[13]杨小华,张伟刚,秦磊,等.Glisson蒂横断联合肝静脉阻断在肝切除术中的应用[J].肝胆胰外科杂志,2014,26(4):272-274.
[14]梁英健,刘连新.肝癌解剖性切除技术要点[J].中国实用外科杂志,2014,34(8):790-792.
[15]黄锦龙,王清,于勇,等.解剖性肝切除对肝细胞癌预后的影响[J].第二军医大学学报,2015,36(5):492-499.
[16]荚卫东.精准肝脏外科时代肝癌多学科治疗[J].实用肝脏病杂志,2015,18(2):120-123.