Glisson蒂横断联合肝静脉阻断在肝切除术中的应用

目的探讨Glisson蒂横断联合肝静脉阻断术在肝脏手术中的运用。方法回顾性分析我院2009年1月至2011年12月20例采用Gllsson蒂横断联合肝静脉阻断术行肝脏切除患者的资料。结果其中解剖性肝切除15例，非解剖性肝切除5例。包括左外叶切除（Ⅱ＋Ⅲ）3例，左半肝切除（Ⅱ＋Ⅲ＋Ⅳ）8例，右前叶切除（Ⅴ＋Ⅷ）2例，右后叶切除（Ⅵ＋Ⅷ）1例，右半肝切除（Ⅴ＋Ⅵ＋Ⅶ＋vm）1例，局部剜除5例。20例肝脏手术中解剖性肝切除占75％（15／20），非解剖性占25％（5／20），平均手术时间220（120～380）min，平均失血量300（100～600）mL，术后并发胆瘘1例，经保守治疗后好转。结论Glisson蒂横断联合肝静脉阻断肝切除术能够最大限度的减少肝脏出血，保护残肝功能，提高术后患者的预后。

The application of hepatectomy with Glissonean pedicle transection associated with control of hepatic veins technique for hepatic resection

Objective To evaluate the value of Glissonean pedicle blood occlusion associated with control of hepatic veins technique in the liver resection. Mehods The clinical data of 20 patients who underwent the liver resection using Glissonean pedicle blood occlusion associated with control of hepatic veins in our hospital were retrospectively analyzed. Results Fifteen cases underwent anatomical hepatectomy, the rest of cases underwent non-anatomical hepatectomy. Which included left lateral lobectomy （Couinaud Ⅱ＋Ⅲ, n=3）, left hemihepatectomy （Couinaud Ⅱ＋Ⅲ＋Ⅳ, n=8）, right anterior hepatectomy （Couinaud Ⅴ＋Ⅶ, n=2）, the right posterior hepatectomy （Couinaud Ⅵ＋Ⅶ, n= 1）, right hemihepatectomy （Couinaud Ⅴ＋Ⅵ＋Ⅶ＋Ⅷ, n= 1 ）. The average operative time was 220 （120-380） min, the mean blood loss was 300 （100-600） mL. Two patients suffered from bile leakage. Conclusion Glissonean pedicle blood occlusion associated with control of hepatic veins can reduce hemorrhage in the hepatic resection and protect the function of liver.