Anatomical hepatectomy with Glissonian approach for hepatolithiasis
10.3877/cma.j.issn.2095-3232.2016.03.006
- VernacularTitle:Glisson鞘解剖性肝切除术治疗肝内胆管结石
- Author:
Shibin TANG
1
;
Xiaowu CHEN
;
Luyang WU
;
Jianping FENG
;
Qiugen HU
;
Enqiong YU
;
Jian YE
Author Information
1. 南方医科大学附属顺德第一人民医院普通外科
- Keywords:
Cholelithiasis;
Hepatectomy;
Postoperative complications;
Glisson pedicle
- From:
Chinese Journal of Hepatic Surgery（Electronic Edition）
2016;5(3):148-152
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the surgical procedure, characteristics and clinical efficacy of anatomical hepatectomy with Glissonian approach for hepatolithiasis.MethodsClinical data of 37 patients with hepatolithiasis who underwent anatomical hepatectomy with Glissonian approach in the First People's Hospital of Shunde Affiliated to Southern Medical University between May 2009 and July 2014 were retrospectively analyzed. Among the patients, 9 were males and 28 were females with the age ranging from 27 to 83 years old and the median of 53 years old. According to the hepatolithiasis classification of Biliary Tract Surgery Group of Surgery Branch of Chinese Medical Association (2007), 27 cases were with typeⅠhepatolithiasis and 10 cases were with typeⅡ hepatolithiasis. The informed consents of all patients were obtained and the local ethical committee approval was received. Anatomical hepatectomy with Glissonian approach and intraoperative cholangioscopic lithotomy were performed on the patients. The conditions during operation, postoperative complications of bile leakage, liver failure, abdominal infection, and stone clearance rate were observed.ResultsAll patients completed the operations successfully. Four cases underwent resection of single segment, 1 of segmentⅢ and part of segmentⅧ, 10 of left lateral lobe, 13 of left lobe, 1 of segmentⅣ andⅤ, 1 of right anterior lobe, 4 of right posterior lobe, 2 of right lobe, and 1 of left lateral lobe and right posterior lobe. The median length of operation was 300(140-450) min and the intraoperative blood loss was 350(10-800) ml. No death was observed during perioperative period. And no bile leakage, liver failure or abdominal infection was observed after operation. The stone clearance rate of patients with typeⅠand typeⅡ hepatolithiasis was respectively 93%(25/27) and 6/10, and the overall stone clearance rate was 84% (31/37).ConclusionsAnatomical hepatectomy with Glissonian approach has the advantages of relatively easy dissection of intrahepatic ducts, low possibility of accidental injury to biliary ducts, easy discrimination of liver resection border, easy protection of normal caudate lobe and clear intraoperative dissection. Thus, it is a safe and practical liver resection method for hepatolithiasis.
