Application Of Glissonean Pedicle Transection In Hepatocarcinoma

Objective: To explore the security, feasibility and clinical value of Glissoneanpedicle transection method of liver resection for hepatocarcinoma.Methods: Eligible patients with large (>5cm) nodular HCC (n=50) wereassigned to undergo curative hepatectomy using the Glissonean pedicle transectionmethod (n=25) or the Pringle maneuver (n=25). The operation doctor is the sameone.We analysis the surgical situation and postoperative hepatic function of the twogroups of patients, compare the operation time, hepatic blood flow occlusion time,blood loss, intraoperative blood transfusion, postoperative hepatic function recovery,abdominal drainage volume of postoperative two days, postoperative complicationsand postoperative hospitalization time, to find there whether or not exist differencebetween the two groups.Results: The two groups were comparable in age, sex, site and size of the livertumor, segment or lobe intended to be resected, and liver function reserve, and theresults were not significant statistically.All patients underwent successful majorhepatectomies using the assigned method, with the extent of major hepatectomycomparable in the two groups. The Glissonean approach was associated with shorterhepatic inflow interruption (P <0.05), lower volume of blood loss (P <0.001),reduced requirement for transfusion (P <0.001).the abdominal drainage volume ofpostoperative two days of the HVC group was significantly less than Pringle group(P<0.001),the serum alanine aminotransferase (ALT) of postoperative3rd day andpostoperative1st week of the two groups of cases are both higher than that ofpreoperative3rd day (P <0.05), however, the ALT increased volume of thepostoperative3rd day and postoperative1st week compared to preoperative3rd day ofthe Glisson Group were significantly lower than that of Pringle group (P <0.001); theALT of postoperative1st week of the two groups of cases are both lower than that ofpostoperative3rd day (P <0.01), has a significant difference.Conclusions:.1.The Glissonean pedicle transection method only cut off thehepatic blood inflow of the pathological side, retained the hepatic blood inflow of the contralateral liver, the residual liver has a lesser postoperative hepatic dysfunction,liver function recover rapidly, especially beneficial to patients with cirrhosis.2.During the liver resection, the blocking time of the Glissonean pedicletransection method is relatively no limited, there is ample time for finemanipulation,full ligation of small bile ducts and blood vessels, the bleeding andextravasation of the liver section have been significantly reduced. Liver transectiontime is longer, but the treatment of liver section is relatively simple, so the meanoperative time of HVC group is relatively longer, but the results was no difference.,the bleeding and extravasation of the liver section have been significantly reduced.3.The Glissonean pedicle transection method is safe and feasible, but requires thesurgeon has a skilled Glissonean pedicle dissection technique...