关键词: 解剖性肝切除；Glisson蒂入路；腹腔镜检查；门脉流域；肝肿瘤

Abstract: Objective To explore the application of laparoscopic anatomic right anterior lobectomy based on anterrior pedicle-posterior pedicle-right hepatic(APR) triangle approach and laparoscopic ultrasound assisted localization.Methods The clinical data of 28 patients who received laparoscopic anatomic right anterior lobectomy at the Hepatobiliary and Pancreatic Surgery Center of Shiyan Taihe Hospital from January 2018 to August 2022 were retrospectively analyzed.Among them,14 patients were set as the experimental group based on the APR triangle approach and 14 patients were set as the control group who underwent the traditional anterior approach.The basic information,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative liver function and postoperative hospital stay were compared between the experimental group and the control group,and statistical analysis was carried out.Results The two laparoscopic anatomical hepatectomy Methods of right anterior lobectomy were successfully completed.In terms of intraoperative indexes,the operation time of the experimental group [(340.71±45.82) min] and hilar occlusion time [(56.07±11.47) min] were both shorter than those of the control group [(428.92±90.00) min and (68.36±15.96) min],and the differences were statistically significant (P＜0.05).In the experimental group,Serum levels of ALT was (236.51±78.65) U/L at 1 day after surgery, AST was (216.82±95.66)U/L at 1 day after surgery,ALT was (177.23±84.76)U/L at 3 days after surgery,AST was (125.63±55.48) U/L at 3 days after surgery,TBil was (23.57±7.58) μmol/L at 3 days after surgery,which were significantly lower than that in the control group[(658.73±361.55)U/L,(688.88±241.52)U/L,(383.42±199.01)U/L,(232.59±168.5)U/L and (31.46±11.95)μmol/L,respectively](P＜0.05).Compared with the control group[(9.86±2.44)d],the experimental group had shorter postoperative hospital stay[(7.79±1.19)d],the difference were statistically significant(P＜0.05).There was no recurrence or death in the two groups at 90 days after the operation.Conclusion The Glisson pedicle approach based on APR triangle and abdominal ultrasound assisted localization of laparoscopic anatomical right anterior lobectomy have the advantages of shorter operation time,shorter hilar occlusion time,faster postoperative enzymatic recovery of liver function and shorter postoperative hospital stay.There was no significant difference in postoperative complications between the two groups.

Key words: anatomic hepatectomy；Glisson pedicle approach；laparoscop；portal territory；liver neoplasm