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.