CAJ | 학술논문

目的探讨经Glisson鞘路径行腹腔镜肝切除术的可行性及技术要点.方法回顾性分析广西医科大学第一附属医院微创外科在2008年5月至2012年5月期间27例应用经Glisson 鞘路径行腹腔镜肝切除术病例的临床资料.结果本组27例患者中经Glisson鞘路径阻断左肝蒂16例,阻断右肝蒂11例.手术方式包括腹腔镜肝左外叶切除术9例,左半肝切除术6例,右半肝切除术2例,局部性肝切除术10例,其中1例因为离断肝实质过程中肝断面出血而中转开腹手术.平均手术时间(229.07±78.46)min,术中出血(454.81±388.22)ml.输注红细胞(1.74±2.46)U,血浆(162.96±235.58) ml.术后住院时间(12.41±3.86)d.术后2～3d进流质饮食,2～4d肛门排气,3 ～4d下床活动.术后肝功能血清转氨酶、胆红素及白蛋白的检测结果7～14d后恢复正常.术后并发症包括腹水2例,胸腔积液1例,胆漏1例,均经过内科保守治疗后痊愈出院.截止2012年5月,24例肝癌患者术后获得随访,随访时间1～49个月,平均(21.0±11.0)个月.随访患者的1年生存率75％,3年生存率8.3％.结论经Glisson鞘路径行腹腔镜肝切除术是可行及有效的.
목적 탐토경Glisson초로경행복강경간절제술적가행성급기술요점.방법 회고성분석엄서의과대학제일부속의원미창외과재2008년5월지2012년5월기간27례응용경Glisson 초로경행복강경간절제술병례적림상자료.결과 본조27례환자중경Glisson초로경조단좌간체16례,조단우간체11례.수술방식포괄복강경간좌외협절제술9례,좌반간절제술6례,우반간절제술2례,국부성간절제술10례,기중1례인위리단간실질과정중간단면출혈이중전개복수술.평균수술시간(229.07±78.46)min,술중출혈(454.81±388.22)ml.수주홍세포(1.74±2.46)U,혈장(162.96±235.58) ml.술후주원시간(12.41±3.86)d.술후2～3d진류질음식,2～4d항문배기,3 ～4d하상활동.술후간공능혈청전안매、담홍소급백단백적검측결과7～14d후회복정상.술후병발증포괄복수2례,흉강적액1례,담루1례,균경과내과보수치료후전유출원.절지2012년5월,24례간암환자술후획득수방,수방시간1～49개월,평균(21.0±11.0)개월.수방환자적1년생존솔75％,3년생존솔8.3％.결론 경Glisson초로경행복강경간절제술시가행급유효적.
Objective To evaluate the feasibility and technique of trans-intrahepatic Glissoni capsula approach for laparoscopic hepatectomy.Methods Between May 2008 and May 2012,the perioperative and postoperative outcomes of 27 cases undergoing laparoscopic hepatectomy using the intrahepatic Glisson approach at author's department were retrospectively analyzed.Results Left hepatic pedicle was controlled through intrahepatic Glisson pedicle in 16 patients.Right hepatic pedicle was controlled in 11 patients by the same maneuver.Left lateral segmentectomy was performed in 9 patients,left hepatectomy in 6 patients,right hepatectomy in 2 patients,tumor local resection in 10 patients,and conversion to open surgery in 1 patient because of bleeding during the parenchymal transection.There was no operative mortality.The mean operative time was (229.07 78.46) min,mean operative blood loss was (454.81 ± 388.22) ml,concentrate blood cells transfusion volume was (1.74 ± 2.46) U,and plasma transfusion volume was (162.96 ±235.58) ml.The mean postoperative hospital stay was (12.41 ± 3.86)days.The liver function were back to normal level on postoperative 7-14 days.Complications included ascites in 2 patients,pleural effusion in 1 patient,biliary fistula in 1 patient.These complications were cured by conservative therapy.As of May 2012,24 cases with liver cancer were followed-up.The follow-up time ranged from 1 to 49 months and mean time was (21.0 ± 11.0) months,survival rate was 75％ in 1-year and 8.3％ in 3-year.Conclusions The trans-Glissoni capsula fibrosa approach used for laparoscopic hepatectomy is feasible and effective.