Glisson蒂横断式肝中叶切除治疗合并肝硬化的肝细胞癌安全性及疗效
|
摘要
目的探讨Glisson蒂横断式肝中叶切除治疗合并肝硬化的肝细胞癌(肝癌)安全性及疗效。方法回顾性分析2014年6月至2017年3月在佛山市第一人民医院行Glisson蒂横断式肝中叶切除的20例合并肝硬化的肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男15例,女5例;年龄31~64岁,中位年龄48岁。肝功能Child-Pugh分级A级18例,B级2例。吲哚氰绿15 min滞留率中位数为0.058(0.034~0.099),肿瘤直径6.6(3.0~13.0)cm。结果所有患者均顺利实施Glisson蒂横断式肝中叶切除。第一肝门阻断时间23(15~30)min,右半肝血流阻断时间67(60~80) min,手术时间390(300~480) min,术中出血量590(200~1 500)ml,术中输血率20%(4/20)。术后发生胆漏2例,行经皮穿刺引流后治愈;无围手术期死亡。随访时间156~240个月,随访期间3例肿瘤复发。结论 Glisson蒂横断式肝中叶切除安全、有效,选择合适病例,掌握Glisson蒂分离的技巧,精准把控切除平面,可实现解剖性精准肝切除,尤其适合合并肝硬化的肝癌患者。
Objective To investigate the clinical efficacy and safety of mesohepatectomy with Glissonean pedicle transection in the treatment of hepatocellular carcinoma(HCC) complicated with liver cirrhosis. Methods Clinical data of 20 patients with HCC complicated with liver cirrhosis who underwent mesohepatectomy with Glissonean pedicle transection in the First People's Hospital of Foshan from June 2014 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 20 patients, 15 cases were male and 5 female, aged 31-64 years with a median age of 48 years. 18 patients was classified with liver function Child-Pugh grade A and 2 were Child-Pugh grade B. The median indocyanine green(ICG) retention rate at 15 minutes was 0.058(0.034-0.099) and the tumor diameter was 6.6(3.0-13.0) cm. Results Mesohepatectomy with Glissonean pedicle transection was successfully performed in all patients. The length of porta hepatis occlusion was 23(15-30) min, and the right lobe was 67(60-80) min. The operation time was 390(300-480) min, the intraoperative blood loss was 590(200-1 500) ml and the intraoperative blood transfusion rate was 20%(4/20). After operation, bile leakage occurred in 2 cases, and they were cured after percutaneous drainage. No perioperative death was observed. The follow-up time was 156 to 240 months. 3 cases suffered tumor recurrence during the follow-up period. Conclusions Mesohepatectomy with Glissonean pedicle transection is safe and effective. Precise anatomical hepatectomy can be achieved by choosing suitable patients, having proficient skill in Glissonean pedicle transection and precisely defining cutting surface, especially for patients with HCC complicated with liver cirrhosis.
Objective To investigate the clinical efficacy and safety of mesohepatectomy with Glissonean pedicle transection in the treatment of hepatocellular carcinoma(HCC) complicated with liver cirrhosis. Methods Clinical data of 20 patients with HCC complicated with liver cirrhosis who underwent mesohepatectomy with Glissonean pedicle transection in the First People's Hospital of Foshan from June 2014 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 20 patients, 15 cases were male and 5 female, aged 31-64 years with a median age of 48 years. 18 patients was classified with liver function Child-Pugh grade A and 2 were Child-Pugh grade B. The median indocyanine green(ICG) retention rate at 15 minutes was 0.058(0.034-0.099) and the tumor diameter was 6.6(3.0-13.0) cm. Results Mesohepatectomy with Glissonean pedicle transection was successfully performed in all patients. The length of porta hepatis occlusion was 23(15-30) min, and the right lobe was 67(60-80) min. The operation time was 390(300-480) min, the intraoperative blood loss was 590(200-1 500) ml and the intraoperative blood transfusion rate was 20%(4/20). After operation, bile leakage occurred in 2 cases, and they were cured after percutaneous drainage. No perioperative death was observed. The follow-up time was 156 to 240 months. 3 cases suffered tumor recurrence during the follow-up period. Conclusions Mesohepatectomy with Glissonean pedicle transection is safe and effective. Precise anatomical hepatectomy can be achieved by choosing suitable patients, having proficient skill in Glissonean pedicle transection and precisely defining cutting surface, especially for patients with HCC complicated with liver cirrhosis.
引文
[1]Takasaki K.Glissonean pedicle transection method for hepatic resection:a new concept of liver segmentation[J].J Hepatobiliary Pancreat Surg,1998,5(3):286-291.
[2]Takasaki K.Hepatic resection using glissonean pedicle transection[J].Nihon Geka Gakkai Zasshi,1998,99(4):245-250.
[3]Sugioka A,Kato Y,Tanahashi Y.Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule:proposal of a novel comprehensive surgical anatomy of the liver[J].J Hepatobiliary Pancreat Sci,2017,24(1):17-23.
[4]付必莽,唐继红,孙勇,等.256层智能CT肝门脉三维重建及分型对Glisson鞘横断肝切除的指导[J].中国医学影像学杂志,2011,19(5):388-393.
[5]Launois B,Jamieson GG.The importance of Glisson's capsule and its sheaths in the intrahepatic approach to resection of the liver[J].Surg Gyngcol Obstet,1992,174(1):7-10.
[6]Machado MA,Herman P,Figueira ER,et al.Intrahepatic Glissonian access for segmental liver resection in cirrhotic patients[J].Am JSurg,2006,192(3):388-392.
[7]Huanwei C,Feiwen D.Pure laparoscopic right hemihepatectomy via anterior approach[J].Surg Endosc,2016,30(12):5621.
[8]Chen HW,Deng FW,Hu JY,et al.Extra-glissonian approach for total laparoscopic left hepatectomy:a prosective cohort study[J].Surg Laparosc Endosc Percutan Tech,2017,27(6):e145-148.
[9]Chen YJ,Zhen ZJ,Chen HW,et al.Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach[J].Hepatobiliary Pancreat Dis Int,2014,13(5):508-512.
[10]Zhang Y,Yang H,Deng X,et al.Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extraglissonian approach in laparoscopic liver resection[J].Surg Endosc,2016,30(3):961-970.
[11]Herman P,Krüger J,Lupinacci R,et al.Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a halfPringle maneuver[J].Surg Endosc,2013,27(5):1840-1841.
[12]Wang HQ,Yang JY,Yan LN.Hemihepatic versus total hepatic inflow occlusion during hepatectomy:a systematic review and metaanalysis[J].World J Gastroenterol,2011,17(26):3158-3164.
[13]Kirchner VA,Kim KH,Kim SH,et al.Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure[J].Surg Endosc,2017,31(8):3349-3350.
[14]陈曦,周存才,周红兵,等.肝蒂横断式肝切除在解剖性肝中叶切除术中的应用[J].中国普通外科杂志,2012,21(7):791-795.
[15]胡继雄,戴卫东,苗雄鹰,等.经Glisson途径切除肝中叶治疗原发性肝癌[J].中国实用外科杂志,2009,29(11):930-932.
[16]杨连粤,裴雷,欧迪鹏,等.中肝叶切除治疗中央型大肝癌[J].中华肝胆外科杂志,2012,18(4):245-248.
[17]Jarnagin WR,Gonen M,Fong Y,et al.Improvement in perioperative outcome after hepatic resection:analysis of 1,803 consecutive cases over the past decade[J].Ann Surg,2002,236(4):397-406.
[18]吴诺林,耿小平,赵红川,等.肝中叶切除术治疗中央区大肝癌25例临床分析[J].中华普通外科杂志,2013,28(3):200-204.
[19]Lee SY.Central hepatectomy for centrally located malignant liver tumors:a systematic review[J].World J Hepatol,2014,6(5):347-357.
[2]Takasaki K.Hepatic resection using glissonean pedicle transection[J].Nihon Geka Gakkai Zasshi,1998,99(4):245-250.
[3]Sugioka A,Kato Y,Tanahashi Y.Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule:proposal of a novel comprehensive surgical anatomy of the liver[J].J Hepatobiliary Pancreat Sci,2017,24(1):17-23.
[4]付必莽,唐继红,孙勇,等.256层智能CT肝门脉三维重建及分型对Glisson鞘横断肝切除的指导[J].中国医学影像学杂志,2011,19(5):388-393.
[5]Launois B,Jamieson GG.The importance of Glisson's capsule and its sheaths in the intrahepatic approach to resection of the liver[J].Surg Gyngcol Obstet,1992,174(1):7-10.
[6]Machado MA,Herman P,Figueira ER,et al.Intrahepatic Glissonian access for segmental liver resection in cirrhotic patients[J].Am JSurg,2006,192(3):388-392.
[7]Huanwei C,Feiwen D.Pure laparoscopic right hemihepatectomy via anterior approach[J].Surg Endosc,2016,30(12):5621.
[8]Chen HW,Deng FW,Hu JY,et al.Extra-glissonian approach for total laparoscopic left hepatectomy:a prosective cohort study[J].Surg Laparosc Endosc Percutan Tech,2017,27(6):e145-148.
[9]Chen YJ,Zhen ZJ,Chen HW,et al.Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach[J].Hepatobiliary Pancreat Dis Int,2014,13(5):508-512.
[10]Zhang Y,Yang H,Deng X,et al.Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extraglissonian approach in laparoscopic liver resection[J].Surg Endosc,2016,30(3):961-970.
[11]Herman P,Krüger J,Lupinacci R,et al.Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a halfPringle maneuver[J].Surg Endosc,2013,27(5):1840-1841.
[12]Wang HQ,Yang JY,Yan LN.Hemihepatic versus total hepatic inflow occlusion during hepatectomy:a systematic review and metaanalysis[J].World J Gastroenterol,2011,17(26):3158-3164.
[13]Kirchner VA,Kim KH,Kim SH,et al.Pure laparoscopic right anterior sectionectomy for hepatocellular carcinoma with great vascular exposure[J].Surg Endosc,2017,31(8):3349-3350.
[14]陈曦,周存才,周红兵,等.肝蒂横断式肝切除在解剖性肝中叶切除术中的应用[J].中国普通外科杂志,2012,21(7):791-795.
[15]胡继雄,戴卫东,苗雄鹰,等.经Glisson途径切除肝中叶治疗原发性肝癌[J].中国实用外科杂志,2009,29(11):930-932.
[16]杨连粤,裴雷,欧迪鹏,等.中肝叶切除治疗中央型大肝癌[J].中华肝胆外科杂志,2012,18(4):245-248.
[17]Jarnagin WR,Gonen M,Fong Y,et al.Improvement in perioperative outcome after hepatic resection:analysis of 1,803 consecutive cases over the past decade[J].Ann Surg,2002,236(4):397-406.
[18]吴诺林,耿小平,赵红川,等.肝中叶切除术治疗中央区大肝癌25例临床分析[J].中华普通外科杂志,2013,28(3):200-204.
[19]Lee SY.Central hepatectomy for centrally located malignant liver tumors:a systematic review[J].World J Hepatol,2014,6(5):347-357.