To explore the safety and effectiveness of Glisson pedicle transection hepatectomy in the resection of childhood hepatoblastoma.

Sixteen children whose pathological diagnosis was confirmed to be hepatoblastoma admitted to the Department of Hepatobiliary Surgery, PLA Rocket Force Characteristic Medical Center from April 2018 to December 2019 were selected. All child patients completed 3 cycles of neoadjuvant chemotherapy (C5VD regimen) before operation. The related examinations, the whole liver volume and residual liver volume were accurately measured, and indocyanine green test was performed to evaluate the liver reserve function. The operation was performed by Glisson pedicle transection. During the operation, the hilum was first dissected, and the left, middle, and right hepatic pedicles were dissected and suspended outside the sheath. According to the needs of different liver segments, the corresponding liver pedicle was blocked in a planned way to accurately control the blood flow into the liver. When performed left hepatectomy, first blocked the left hepatic pedicle and then cut the liver along the ischemic line. When performed right hepatectomy, first blocked the right hepatic pedicle and the middle hepatic pedicle and then cut the liver along the ischemic line. When performed hepatic S_{5, 8} resection, first blocked the left hepatic pedicle and the middle hepatic pedicle along the ischemic line to cut the left side of the S_{5, 8} segment, and then blocked the middle and right hepatic pedicles to cut the liver along the ischemic line to the right of the S_{5, 8} segment marginal liver. When the left third hepatectomy was performed, the middle and left hepatic pedicles were completely blocked, and the liver was cut along the ischemic line between S_{5, 8} and S_{6, 7}. In the right third liver resection, on the basis of ligating and transected the right hepatic pedicle and the middle hepatic pedicle, the Glisson pedicle which dominates the S₄ segment was also cut along the round ligament of the liver. At this time, the liver surface could show the ischemic line between the S₄ segment and the S_{2, 3} segment, and the right three liver tissues including the S_{4, 5, 6, 7, 8} segments were removed along the ischemic line. Counted the child patients′ operation time, intraoperative blood loss, intraoperative blood transfusion, occurrence of serious postoperative complications, tumor pathological classification; re-check the levels of glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), determined the plasma prothrombin time (PT), and international normalized ratio (INR) one week after surgery. The child patients′ hospital stay was recorded; at 1, 3, and 6 months after discharge, abdominal ultrasound, blood routine, GOT, GPT, INR were reviewed in the outpatient clinic, and normal abdominal CT scans and enhanced scans were reviewed at 12 and 18 months after discharge.

All 16 children underwent Glisson pedicle transection to complete the operation successfully. Among them, 4 cases completed standard left hepatectomy by transecting the left hepatic pedicle, 5 cases completed standard right hepatectomy by transecting the right and middle hepatic pedicle, 3 cases completed standard left three hepatectomy by transecting the left hepatic pedicle, middle hepatic pedicle and S_{5, 8} liver pedicle, and 4 cases of standard right third hepatectomy by cutting right hepatic pedicle, middle hepatic pedicle and some third-order branches of left hepatic pedicle. The average operation time was (208.1 ± 45.2) min, the average intraoperative blood loss was (268.7 ± 99.8) mL, and the average intraoperative blood transfusion was (200.5±50.6) mL. Bile leakage occurred in 1 case after operation, which was cured after adequate drainage and conservative treatment. No perioperative death occurred, no serious complications such as postoperative bleeding, hepatic failure, and pulmonary vein embolism occurred. The pathological results of postoperative specimens showed that among the 16 child patients, 9 cases (56.3%) of simple fetal type, 4 cases (25.0%) of mixed fetal type and embryo type, 2 cases (12.5%) of mixed epithelial and mesenchymal type 1 case (6.2%) of small cell undifferentiated type. One week after surgery, the levels of GOT (64.6±20.4) U/L, GPT (70.2±14.5) U/L, PT (12.2±1.6) s, INR (1.2±0.2), and the average hospital stay was (8.4±1.2) d. Outpatient follow-up for 3 to 18 months, at 1st, 3rd, 6th months after discharge, the outpatient re-examination of abdominal ultrasound showed no local recurrence, blood routine and GOT, GPT, INR were normal. In the 12th and 18th month after discharge, the general CT scan and enhanced scan of the abdomen were normal. No tumor recurred during the follow-up period.

The use of Glisson pedicle hepatectomy for hepatoblastoma in child is simple, safe, fast and effective. For complete resection of the tumor, protecting the function of the remaining liver tissue, reducing intraoperative bleeding is particularly obvious, which is conducive to the rapid recovery of children after operation.