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中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 453 -456. doi: 10.3877/cma.j.issn.1674-3946.2025.04.027.

论著

改良Glisson鞘外阻断在腹腔镜解剖性左半肝切除术中的应用研究
黎伟忠1,(), 黎嘉历1, 张映南2, 莫灿荣1   
  1. 1. 523000 广东东莞,东莞市人民医院普外科
    2. 523000 广东东莞,东莞市人民医院泌尿外科
  • 收稿日期:2024-06-17 出版日期:2025-08-26
  • 通信作者: 黎伟忠
  • 基金资助:
    东莞市社会科技发展项目(2018507150011384)

Applied research on the modified extrahepatic glissonian pedicle transection in laparoscopic anatomical left hepatectomy

Weizhong Li1,(), Jiali Li1, Yingnan Zhang2, Canrong Mo1   

  1. 1. Department of General Surgery, Dongguan People’s Hospital, Dongguan Guangdong Province 523000, China
    2. Department of Urology, Dongguan People’s Hospital, Dongguan GuangdongProvince 523000, China
  • Received:2024-06-17 Published:2025-08-26
  • Corresponding author: Weizhong Li
引用本文:

黎伟忠, 黎嘉历, 张映南, 莫灿荣. 改良Glisson鞘外阻断在腹腔镜解剖性左半肝切除术中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 453-456.

Weizhong Li, Jiali Li, Yingnan Zhang, Canrong Mo. Applied research on the modified extrahepatic glissonian pedicle transection in laparoscopic anatomical left hepatectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 453-456.

目的

分析改良Glisson鞘外阻断在腹腔镜解剖性左半肝切除术(LALH)中的临床应用效果。

方法

回顾性分析2019年1月至2023年6月60例原发性肝癌患者资料,根据术中血流阻断方式不同分为两组,每组各30例,观察组采用改良Glisson鞘外解剖阻断血流,对照组采用常规Glisson鞘内解剖阻断血流。采用软件SPSS 20.0统计分析数据。围手术期指标、肝功能指标等符合正态分布的计量资料用()表示,采用独立样本t检验;术中出血量等不符合正态分布的采用中位数(四分位距)表示,采用非参数检验;并发症等计数资料比较用χ2检验;用Kaplan-Meier生存分析两组患者预后。P<0.05表示差异有统计学意义。

结果

观察组手术时间、左肝蒂解剖时间、术中出血量及术后引流管拔除时间均少于对照组(P<0.05);观察组患者术后血清总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶 (ALT)水平低于对照组(P<0.05);两组患者并发症总发生率差异无统计学意义(P>0.05);两者术后累积无病生存(76.7% vs. 73.3%)和累积总生存(86.7% vs. 80.0%)比较,差异无统计学意义(Log-Rank χ2=0.061/0.172,P=0.873/0.678)。

结论

LALH术中应用改良Glisson鞘外阻断可安全、高效打开鞘外无血通路,精确快速地控制左半肝入肝血流,具有与传统Glisson鞘内解剖阻断血流相同的手术安全性和临床预后。

Objective

To analyze the clinical application effect of the modified extrahepatic Glissonian pedicle transection in laparoscopic anatomical left hepatectomy (LALH).

Methods

The data of 60 patients with primary liver cancer from January 2019 to June 2023 were retrospectively analyzed. According to different methods of intraoperative blood flow occlusion, they were divided into two groups, with 30 patients in each group. The observation group adopted the modified extrahepatic Glissonian pedicle transection to occlude the blood flow, while the control group adopted the conventional intrahepatic Glissonian pedicle transection to occlude the blood flow. The software SPSS 20.0 was used for statistical analysis of the data. Measurement data that conformed to the normal distribution, such as perioperative indexes and liver function indexes, were expressed as (), and independent sample t test was used; the intraoperative blood loss and other data that did not conform to the normal distribution were expressed as median (interquartile range), and nonparametric test was used; the chi-square test was used for the comparison of counting data such as complications; and the Kaplan-Meier survival analysis was used to evaluate the prognosis of the patients in the two groups. P<0.05 indicated that the difference was statistically significant.

Results

The operation time, the anatomical time of the left hepatic pedicle, the intraoperative blood loss and the time of postoperative drainage tube removal in the observation group were all less than those in the control group (P<0.05); the levels of postoperative serum total bilirubin (TBIL), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the observation group were lower than those in the control group (P<0.05); there was no statistically significant difference in the total incidence of complications between the two groups (P>0.05); there was no statistically significant difference in the postoperative cumulative disease-free survival (76.7% vs. 73.3%) and cumulative overall survival(86.7% vs. 80.0%) between the two groups (Log-Rank χ²=0.061/0.172, P=0.873/0.678).

Conclusion

The application of the modified extrahepatic Glissonian pedicle transection during LALH can safely and efficiently open the bloodless extrahepatic pathway, accurately and rapidly control the inflow blood flow of the left half of the liver, and simplify the surgical operation. It has the same surgical safety and clinical prognosis as the traditional intrahepatic Glissonian pedicle transection for blood flow occlusion.

表1 两组LALH手术患者一般临床资料比较
表2 两组LALH手术患者围手术期指标比较
表3 两组LALH手术患者肝功能指标比较(
表4 两组LALH手术患者并发症发生情况比较[例(%)]
图1 两组LALH手术患者术后生存分析曲线
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