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

doi:10.3877/cma.j.issn.1674-3946.2025.04.027.

Abstract

Abstract:

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.

Key words: Primary Liver Cancer, Anatomic Left Hemihepatectomy, Laparoscopes

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

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.04.027.

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Figures/Tables 5

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI　（kg/m²， $\overset{ˉ}{x}$ ± s ）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI　（kg/m²， $\overset{ˉ}{x}$ ± s ）
观察组	30	17/13	55. 4±6. 5	22. 9±2. 8
对照组	30	20/10	55. 7±7. 4	23. 7±2. 6
χ ²/t 值		0. 635	0. 167	1. 147
P值		0. 426	0. 868	0. 256
组别	例数	肿瘤直径　（cm， $\overset{ˉ}{x}$ ± s ）	Child-Pugh分级（例）
组别	例数	肿瘤直径　（cm， $\overset{ˉ}{x}$ ± s ）	A/B
观察组	30	5. 80. 7	18/12
对照组	30	5. 60. 8	16/14
χ ²/t 值		1. 031	0. 272
P值		0. 307	0. 602

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI　（kg/m²， $\overset{ˉ}{x}$ ± s ）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI　（kg/m²， $\overset{ˉ}{x}$ ± s ）
观察组	30	17/13	55. 4±6. 5	22. 9±2. 8
对照组	30	20/10	55. 7±7. 4	23. 7±2. 6
χ ²/t 值		0. 635	0. 167	1. 147
P值		0. 426	0. 868	0. 256
组别	例数	肿瘤直径　（cm， $\overset{ˉ}{x}$ ± s ）	Child-Pugh分级（例）
组别	例数	肿瘤直径　（cm， $\overset{ˉ}{x}$ ± s ）	A/B
观察组	30	5. 80. 7	18/12
对照组	30	5. 60. 8	16/14
χ ²/t 值		1. 031	0. 272
P值		0. 307	0. 602

组别	例数	手术时间　（min， $\overset{ˉ}{x}$ ± s ）	左肝蒂解剖时间（min， $\overset{ˉ}{x}$ ± s ）	术中出血量　（ml，IQR）
观察组	30	125. 4±29. 4	14. 9±5. 6	325. 4（253. 5，422. 1）
对照组	30	159. 2±36. 5	22. 2±6. 3	395. 7（262. 9，538. 0）
t/χ ²值		3. 950	4. 744	6. 396
P值		0. 001	0. 000	0. 036
组别	例数	术中输血（例）	首次排气时间（d， $\overset{ˉ}{x}$ ± s ）	引流管拔除时间（d， $\overset{ˉ}{x}$ ± s ）	术后住院时间（d， $\overset{ˉ}{x}$ ± s ）
观察组	30	2	2. 2±0. 7	3. 5±0. 7	8. 4±0. 9
对照组	30	3	2. 0±0. 4	4. 0±0. 9	8. 9±1. 2
t/χ ²值		0. 218	1. 359	2. 402	1. 826
P值		0. 640	0. 179	0. 020	0. 073

组别	例数	手术时间　（min， $\overset{ˉ}{x}$ ± s ）	左肝蒂解剖时间（min， $\overset{ˉ}{x}$ ± s ）	术中出血量　（ml，IQR）
观察组	30	125. 4±29. 4	14. 9±5. 6	325. 4（253. 5，422. 1）
对照组	30	159. 2±36. 5	22. 2±6. 3	395. 7（262. 9，538. 0）
t/χ ²值		3. 950	4. 744	6. 396
P值		0. 001	0. 000	0. 036
组别	例数	术中输血（例）	首次排气时间（d， $\overset{ˉ}{x}$ ± s ）	引流管拔除时间（d， $\overset{ˉ}{x}$ ± s ）	术后住院时间（d， $\overset{ˉ}{x}$ ± s ）
观察组	30	2	2. 2±0. 7	3. 5±0. 7	8. 4±0. 9
对照组	30	3	2. 0±0. 4	4. 0±0. 9	8. 9±1. 2
t/χ ²值		0. 218	1. 359	2. 402	1. 826
P值		0. 640	0. 179	0. 020	0. 073

组别	例数	时间	TBIL（μmol/L）	AST（U/L）	ALT（U/L）
观察组	30	术前	11. 7±2. 9	22. 7±7. 9	24. 3±9. 8
		术后	23. 6±6. 5^a	152. 9±30. 2^a	174. 8±41. 3^a
对照组	30	术前	12. 2±2. 8	22. 5±8. 7	23. 9±9. 5
		术后	28. 7±6. 2	185. 4±36. 3	194. 8±44. 5

组别	例数	感染	出血	腹腔脓肿	胆瘘	肝脏断面积液	总发生
观察组	30	2（6. 7）	1（3. 3）	1（3. 3）	0（0. 0）	1（3. 3）	5（16. 7）
对照组	30	3（10. 0）	0（0. 0）	2（6. 7）	1（3. 3）	1（3. 3）	7（23. 3）
χ ²值		-	-	-	-	-	0. 417
P值		-	-	-	-	-	0. 519

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