CAJ | 학술논문

目的探讨Glisson蒂横断式肝切除术在治疗肝细胞癌（肝癌）中的应用价值。方法回顾性分析2002年1月至2012年12月在西安交通大学医学院第一附属医院行根治性肝切除术的54例肝癌患者临床资料。根据手术方法将患者分为Glisson蒂横断式肝切除术组（Glisson组）和Pringle法肝切除术组（Pringle组），每组27例。所有患者均签署知情同意书，符合医学伦理学规定。Glisson组采用游离、阻断Glisson蒂后行肝切除术，Pringle组采用Pringle法阻断第一肝门后行肝切除术。观察两组术中情况、术后肝功能变化及并发症发生情况。术后患者接受随访，并进行生存分析。两组计量资料比较采用t检验，率的比较采用χ2检验或Fisher确切概率法。生存分析采用Kaplan-Meier法和Log-rank检验。结果 Glisson组术中平均出血量为（135±57）ml，明显少于Pringle组的（248±87）ml（t=-5.62，P<0.05）。Glisson组患者术后1 d的TB为（23±5）μmol/L，明显低于Pringle组的（34±5）μmol/L（t=-8.08，P<0.05）。Glisson组术后发生出血2例、感染2例， Pringle组术后发生出血3例、感染1例、胆漏1例，两组术后并发症发生率比较差异无统计学意义（P>0.05）。Glisson组患者1、3、5年累积生存率分别为89%、50%、39%，Pringle组相应为82%、55%、41%；Glisson组患者1、3、5年无瘤生存率分别为89%、43%、34%，Pringle组相应为82%、47%、41%。两组累积生存率及无瘤生存率比较差异均无统计学意义（χ2=0.001，0.011；P>0.05）。结论Glisson蒂横断式肝切除术具有出血量少、肝损伤轻等优点，是治疗肝癌的安全、有效、可行的手术方法。
목적탐토Glisson체횡단식간절제술재치료간세포암（간암）중적응용개치。방법회고성분석2002년1월지2012년12월재서안교통대학의학원제일부속의원행근치성간절제술적54례간암환자림상자료。근거수술방법장환자분위Glisson체횡단식간절제술조（Glisson조）화Pringle법간절제술조（Pringle조），매조27례。소유환자균첨서지정동의서，부합의학윤리학규정。Glisson조채용유리、조단Glisson체후행간절제술，Pringle조채용Pringle법조단제일간문후행간절제술。관찰량조술중정황、술후간공능변화급병발증발생정황。술후환자접수수방，병진행생존분석。량조계량자료비교채용t검험，솔적비교채용χ2검험혹Fisher학절개솔법。생존분석채용Kaplan-Meier법화Log-rank검험。결과 Glisson조술중평균출혈량위（135±57）ml，명현소우Pringle조적（248±87）ml（t=-5.62，P<0.05）。Glisson조환자술후1 d적TB위（23±5）μmol/L，명현저우Pringle조적（34±5）μmol/L（t=-8.08，P<0.05）。Glisson조술후발생출혈2례、감염2례， Pringle조술후발생출혈3례、감염1례、담루1례，량조술후병발증발생솔비교차이무통계학의의（P>0.05）。Glisson조환자1、3、5년루적생존솔분별위89%、50%、39%，Pringle조상응위82%、55%、41%；Glisson조환자1、3、5년무류생존솔분별위89%、43%、34%，Pringle조상응위82%、47%、41%。량조루적생존솔급무류생존솔비교차이균무통계학의의（χ2=0.001，0.011；P>0.05）。결론Glisson체횡단식간절제술구유출혈량소、간손상경등우점，시치료간암적안전、유효、가행적수술방법。
Objective To investigate the application value of hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma (HCC). Methods Clinical data of 54 patients with HCC undergoing radical hepatectomy in the First Affiliated Hospital of Medical College, Xi’an Jiaotong University from January 2002 to December 2012 were analyzed retrospectively. According to different surgical procedure, the patients were divided into hepatectomy with Glissonean pedicle transection group (Glisson group) and hepatectomy with Pringle maneuver (Pringle group) with 27 cases in each group. The informed consents of all patients were obtained and the ethical committee approval was received. In Glisson group, hepatectomy was performed after Glissonean pedicles were dissected and occluded. In Pringle group, hepatectomy was performed after the ifrst porta was occluded using Pringle maneuver. The intraoperative situation, the variation of liver function and incidence of complications after operation of two groups were observed. The patients received follow-up after operation and survival analysis was conducted. The comparison of measurement data between two groups was conducted using t test, the comparison of rates using Chi-square test or Fisher's exact probability test, and the survival analysis using Kaplan-Meier method and Log-rank test. Results The mean of intraoperative blood loss in Glisson group [(135±57) ml] was signiifcantly less than that in Pringle group[(248±87) ml] (t=-5.62, P<0.05). The total bilirubin (TB) level 1 d after operation in Glisson group [(23±5) μmol/L] was significantly lower than that in Pringle group [(34±5) μmol/L] (t=-8.08, P<0.05). In Glisson group, postoperative hemorrhage was observed in 2 cases and infection in 2 cases. In Pringle group, postoperative hemorrhage was observed in 3 cases, infection in 1 case, and bile leakage in 1 case. No signiifcant difference was observed in the incidence of postoperative complications between two groups (P>0.05). The 1-, 3-, 5-year cumulative survival rates were 89%, 50%, 39%in Glisson group and were 82%, 55%, 41%in Pringle group. The 1-, 3-, 5-year disease-free survival rates were 89%, 43%, 34%in Glisson group and were 82%, 47%, 41%in Pringle group. No signiifcant difference was observed in the cumulative survival rates and disease free survival rates between two groups (χ2=0.001, 0.011; P>0.05). Conclusion Hepatectomy using Glissonean pedicle transection is a safe, effective, and feasible surgical procedure for HCC with advantages of less blood loss, milder liver damage.