The Clinical Study of Using Modified Glisson Pedicle Transection Method in The Precise Hepatectomy of Hepatocellular Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FENG Wei ¹ , LIN Bin ¹ ,  QIU Yudong ² , CHEN Zheng ¹ , WANG Qile ¹

1.Department of Hepatobiliary Surgery， Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group， Suqian 223800， Jiangsu Province， China;;
2.Department of Hepatobiliary Surgery， Affiliated Nanjing Drum-Tower Hospital， Medical School of Nanjing University， Nanjing 210008， Jiangsu Province， China;

Corresponding author：

QIU Yudong, Email: yudongqiu510@163.com

Keywords：

Glisson pedicle transection method; Precise hepatectomy; Hepatocellular carcinoma

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Objective 　To explore the safety and feasibility of using modified Glisson pedicle transection method
in the precise hepatectomy of hepatocellular carcinoma （HCC）.
Methods 　Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar.
Results　 There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜
0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）.
Conclusions 　The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.

Citation： FENG Wei,LIN Bin,QIU Yudong,CHEN Zheng,WANG Qile. The Clinical Study of Using Modified Glisson Pedicle Transection Method in The Precise Hepatectomy of Hepatocellular Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 762-767. doi: Copy

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2.	Takasaki K. Glissonean pedicle transection method for hepatic rese-ction：a new concept of liver segmentation[J]. J Hepatobiliary Pancreat Surg， 1998， 5(3)：286-291.
3.	杜正贵，李波，冯曦，等. 脉搏染料光密度法吲哚氰绿排泄试验对评价肝癌切除术后肝功能不全的价值[J]. 中国普外基础与临床杂志， 2009， 16(2)： 133-136.
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9.	Torzilli G， Montorsi M， Del Fabbro D， et al. Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence[J]. Br J Surg， 2006， 93(10)：1238-1246.
10.	Wang WD， Liang LJ， Huang XQ， et al. Low central venous pressure reduces blood loss in hepatectomy[J]. World J Gastroenterol， 2006， 12(6)：935-939.
11.	吴孟超. 我国肝切除技术发展的现状和展望[J]. 中华外科杂志， 2010， 48(3)： 161-162.
12.	丁义涛. 原发性肝癌外科手术过程无血切肝技术的应用[J]. 中华肝胆外科杂志， 2007， 13(1)： 7-9.
13.	Yang ZF， Poon RT， To J， et al. The potential role of hypoxia inducible factor 1alpha in tumor progression after hypoxia and chemotherapy in hepatocellular carcinoma[J]. Cancer Res， 2004， 64(15)：5496-5503.
14.	Fan ST. Precise hepateetomy guided by the middle hepatic vein[J]． Hepatobiliary Panereat Dis Int， 2007， 6(4)： 430-434.
15.	董家鸿，黄志强. 精准肝切除—21世纪肝脏外科新理念[J]. 中华外科杂志， 2009， 47 (21) ： 1601-1605.
16.	Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma[J]. Ann Surg， 1908， 48(4)∶ 541-549.
17.	Man K， Fan ST， Ng IO， et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study[J]. Ann Surg， 1997， 226(6)： 704-7l1.
18.	文天夫，严律南. 肝切除术中肝脏血流阻断技术的研究进展[J]. 中国普外基础与临床杂志， 2008， 15(4)： 299-302.
19.	Takasaki K. Glissonean pedicle transection method for hepatic resection[M]. Tokyo： Springer， 2007： 1-162.
20.	Nakamura T， Tanaka K， Kiuchi T， et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation：lessons from 120 cases[J]. Transplantation， 2002， 73(12)： 1896-1903.
21.	李彦明，张莲香，文玉军，等. 肝门部肝蒂内结构主要分支的形态学观测及临床意义[J]. 宁夏医科大学学报， 2009， 31(3)：299-301.
22.	蔡守旺，谢于，杨世忠，等. 持久美蓝染色法在精准肝切除中的应用价值[J]. 中华消化外科杂志， 2010， 9(1)：28-30.
23.	Smyrniotis V， Kostopanagiotou G， Theodoraki K， et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections[J]. Am J Surg， 2004， 187(3)：398-402.
24.	李升平，张昌卿，冯凯涛，等. 肝癌亚临床转移灶及临床病理学意义的研究[J]. 中国肿瘤临床， 2002， 29：77-81.
25.	Tsuruta K， Okamoto A， Toi M， et al. Highly anatomically syste-matized hepatic resection with Glissonean sheath code transection at the hepatic hilus[J]. Int Surg， 1990， 75(2)：73-77.

1. Llovet JM， Bruix J. Novel advancements in the management of hepatocellular carcinoma in 2008[J]. J Hepatol， 2008， 48 Suppl 1：S20-S37.
2. Takasaki K. Glissonean pedicle transection method for hepatic rese-ction：a new concept of liver segmentation[J]. J Hepatobiliary Pancreat Surg， 1998， 5(3)：286-291.
3. 杜正贵，李波，冯曦，等. 脉搏染料光密度法吲哚氰绿排泄试验对评价肝癌切除术后肝功能不全的价值[J]. 中国普外基础与临床杂志， 2009， 16(2)： 133-136.
4. Poon RT， Fan ST. Hepatectomy for hepatocellular carcinoma：patient selection and postoperative outcome[J]. Liver Tran spl， 2004， 10(2 Suppl 1)：S39-S45.
5. 何鹏，仇毓东，丁义涛，等. 脉动色素浓度测定法行ICG清除试验检测肝储备功能的准确性评价[J]. 中华肝胆外科杂志， 2007， 13(9)：588-590.
6. 林科灿，刘景丰，曾金华，等. 基于肝脏三维图像的肝段自动划分及虚拟解剖性肝切除[J]. 中国普外基础与临床杂志， 2011， 18(7)： 694-697.
7. Yamanaka J， Saito S， Fujimoto J， et al. Impact of preoperative planning using virtual segmental volumetry on liver resection for hepatocellular carcinoma[J]. World J Surg， 2007， 31(6)：1249-1255.
8. 冯伟，林斌，汪启乐，等. 术中超声在肝癌患者肝段精准切除术中的应用[J]. 中华全科医师杂志， 2013， 12(4)：308-309.
9. Torzilli G， Montorsi M， Del Fabbro D， et al. Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence[J]. Br J Surg， 2006， 93(10)：1238-1246.
10. Wang WD， Liang LJ， Huang XQ， et al. Low central venous pressure reduces blood loss in hepatectomy[J]. World J Gastroenterol， 2006， 12(6)：935-939.
11. 吴孟超. 我国肝切除技术发展的现状和展望[J]. 中华外科杂志， 2010， 48(3)： 161-162.
12. 丁义涛. 原发性肝癌外科手术过程无血切肝技术的应用[J]. 中华肝胆外科杂志， 2007， 13(1)： 7-9.
13. Yang ZF， Poon RT， To J， et al. The potential role of hypoxia inducible factor 1alpha in tumor progression after hypoxia and chemotherapy in hepatocellular carcinoma[J]. Cancer Res， 2004， 64(15)：5496-5503.
14. Fan ST. Precise hepateetomy guided by the middle hepatic vein[J]． Hepatobiliary Panereat Dis Int， 2007， 6(4)： 430-434.
15. 董家鸿，黄志强. 精准肝切除—21世纪肝脏外科新理念[J]. 中华外科杂志， 2009， 47 (21) ： 1601-1605.
16. Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma[J]. Ann Surg， 1908， 48(4)∶ 541-549.
17. Man K， Fan ST， Ng IO， et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study[J]. Ann Surg， 1997， 226(6)： 704-7l1.
18. 文天夫，严律南. 肝切除术中肝脏血流阻断技术的研究进展[J]. 中国普外基础与临床杂志， 2008， 15(4)： 299-302.
19. Takasaki K. Glissonean pedicle transection method for hepatic resection[M]. Tokyo： Springer， 2007： 1-162.
20. Nakamura T， Tanaka K， Kiuchi T， et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation：lessons from 120 cases[J]. Transplantation， 2002， 73(12)： 1896-1903.
21. 李彦明，张莲香，文玉军，等. 肝门部肝蒂内结构主要分支的形态学观测及临床意义[J]. 宁夏医科大学学报， 2009， 31(3)：299-301.
22. 蔡守旺，谢于，杨世忠，等. 持久美蓝染色法在精准肝切除中的应用价值[J]. 中华消化外科杂志， 2010， 9(1)：28-30.
23. Smyrniotis V， Kostopanagiotou G， Theodoraki K， et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections[J]. Am J Surg， 2004， 187(3)：398-402.
24. 李升平，张昌卿，冯凯涛，等. 肝癌亚临床转移灶及临床病理学意义的研究[J]. 中国肿瘤临床， 2002， 29：77-81.
25. Tsuruta K， Okamoto A， Toi M， et al. Highly anatomically syste-matized hepatic resection with Glissonean sheath code transection at the hepatic hilus[J]. Int Surg， 1990， 75(2)：73-77.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Clinical Study of Using Modified Glisson Pedicle Transection Method in The Precise Hepatectomy of Hepatocellular Carcinoma

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