摘要
目的探讨经Glisson蒂鞘外解剖路径肝切除术治疗原发性肝癌的临床效果。方法回顾性分析138例行腹腔镜下经Glisson蒂鞘入肝血流阻断肝切除术治疗的原发性肝癌患者的临床资料,按经Glisson蒂鞘入肝血流阻断选择方式分为经Glisson蒂鞘内解剖路径组(内解剖组)81例和经Glisson蒂鞘外解剖路径组(外解剖组)57例。比较两组患者术中指标、术后住院时间、术后7 d血常规与肝功能指标、术后并发症发生率及术后1年病死率。结果两组患者的肝切除范围差异无统计学意义(P>0.05),但外解剖组手术时间、缺血线时间、术中出血量、输血量及输血率均短于或低于内解剖组(均P<0.05)。两组患者术后住院时间及术后7 d血红蛋白、血小板水平比较,差异均无统计学意义(均P>0.05),但外解剖组术后7 d AST、ALT、TBIL水平均高于内解剖组(均P<0.05)。外解剖组术后并发症发生率低于内解剖组(P<0.05),而两组患者术后1年病死率差异无统计学意义(P>0.05)。结论与经Glisson蒂鞘内解剖路径肝切除术相比,经Glisson蒂鞘外解剖路径肝切除术具有缺血线出现早、手术时间短、术中出血量少、输血率及术后并发症发生率低等优势,可促进患者肝功能恢复,安全可行。
Objective To investigate the clinical efficacy of hepatectomy via anatomic extra-Glissonean sheath approach for the treatment of primary liver cancer.Methods The clinical data of 138 patients with primary liver cancer treated by laparoscopic hepatectomy with hepatic in flow occlusion via Glissonean sheath approach were retrospectively analyzed.According to the Glissonean sheath approach hepatic inflow occlusion used,the patients were divided into 81 cases in the anatomic intra-Glissonean sheath approach group(intra-anatomic group)and 57 cases in the anatomic extra-Glissonean sheath approach group(extra-anatomic group).Intraoperative indices,postoperative hospital stay,blood routine and liver function indices 7 days postoperatively,incidence rate of postoperative complications,and postoperative 1-year mortality were compared between the two groups.Results There was no statistically significant difference in hepatectomy extension between the two groups(P>0.05),but the extra-anatomic group had shorter operation duration,shorter ischemia line time,less intraoperative blood loss and blood transfusion volume,and lower blood transfusion rate than the intra-anatomic group(all P<0.05).There was no statistically significant difference between the two groups in postoperative hospital stay,hemoglobin or platelet level 7 days postoperatively(all P>0.05),but the levels of AST,ALT and TBIL 7 days postoperatively in the extra-anatomic group were higher than those in the intra-anatomic group(all P<0.05).The extra-anatomic group exhibited a lower incidence rate of postoperative complications than the intra-anatomic group(P<0.05),whereas no statistically significant difference was found in postoperative 1-year mortality between the two groups(P>0.05).Conclusion Compared with hepatectomy via anatomic intra-Glissonean sheath approach,hepatectomy via anatomic extra-Glissonean sheath approach has the advantages of early occurrence of ischemic line,shorter operation duration,less intraoperative blood loss,lower blood transfusion rate an
作者
郑捷
ZHENG Jie(Department of General Surgery,Liuzhou Traditional Chinese Medicial Hospital,Liuzhou 545001,China)
出处
《广西医学》
CAS
2020年第21期2829-2832,共4页
Guangxi Medical Journal
