Hepatectomy using Glissonean pedicle transection for hepatocellular carcinoma
10.3877/cma.j.issn.2095-3232.2014.04.004
- VernacularTitle:Glisson蒂横断式肝切除术治疗肝细胞癌
- Author:
Xinsen XU
1
;
Wei CHEN
;
Lingqiang ZHANG
;
Xiaogang ZHANG
;
Xuemin LIU
;
Liang YU
;
Yi LYU
;
Chang LIU
Author Information
1. 710061,西安交通大学医学院第一附属医院肝胆外科
- Keywords:
Carcinoma,hepatocellular;
Hepatectomy;
Glissonean pedicle transection method;
Pringle maneuver vascular control;
Blood loss,surgical;
Liver function tests;
Reperfusion injury
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2014;(4):210-214
- CountryChina
- Language:Chinese
-
Abstract:
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.
