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中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 220 -223. doi: 10.3877/cma.j.issn.1674-3946.2019.03.002

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腹腔镜解剖性肝切除手术切面确定原则
刘景丰1,(), 黄尧1, 曾永毅1, 曾金华1, 林科灿1, 罗顺峰1   
  1. 1. 350025,福州,福建医科大学孟超肝胆医院;350005,福州,福建医科大学附属第一医院肝病中心
  • 收稿日期:2018-11-30 出版日期:2019-06-26
  • 通信作者: 刘景丰

Principles for the determination of surgical plane in laparoscopic anatomic hepatectomy

Jingfeng Liu1,(), Yao Huang1, Yongyi Zeng1, Jinhua Zeng1, Kecan Lin1, Shunfeng Luo1   

  1. 1. Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian 350000, China; Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fujian 350005, China
  • Received:2018-11-30 Published:2019-06-26
  • Corresponding author: Jingfeng Liu
  • About author:
    Corresponding author: Liu Jingfeng, Email:
  • Supported by:
    National Natural Science Foundation of China(No. 81871483); Science and Technology Program of Fujian Province(No. 2019Y3001); Struction Program of Liver Disease Center of Fujian Province(No. 2017-171)
引用本文:

刘景丰, 黄尧, 曾永毅, 曾金华, 林科灿, 罗顺峰. 腹腔镜解剖性肝切除手术切面确定原则[J]. 中华普外科手术学杂志(电子版), 2019, 13(03): 220-223.

Jingfeng Liu, Yao Huang, Yongyi Zeng, Jinhua Zeng, Kecan Lin, Shunfeng Luo. Principles for the determination of surgical plane in laparoscopic anatomic hepatectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(03): 220-223.

精确确定手术切面是规范实施腹腔镜解剖性肝切除的技术难点。与开腹手术相比,腹腔镜肝切除由于缺乏开放手术的触感、操作空间限制等原因,在如何确定解剖性肝切除的手术切面方面,有其特殊性。本文就腹腔镜解剖性肝切除确定手术切面的常用的方法,进行小结。目前主要方法有:(1)循肝脏表面解剖标志;(2)循肝静脉路径;(3)预先控制目标肝段肝蒂,循缺血界面;(4)目标肝段门静脉穿刺染色。这些方法各有优缺点,适用于不同的肝段切除。临床实践应根据实际情况,综合应用。

Accurate determination of the surgical plane is a technical difficulty in laparoscopic anatomic hepatectomy. Compared with open surgery, laparoscopic hepatectomy has its own particularity in determining the surgical plane of anatomical hepatectomy due to the lack of sense of touch and the limited operating space. In this paper, some common methods for determining the surgical plane of laparoscopic anatomical hepatectomy were summarized. The mainly methods include: (1)according to the anatomical landmarks on the surface of the liver; (2)guided by the hepatic vein; (3) the selective portal pedicle clamping of the target liver segment; (4) target liver segment portal vein puncture staining. Each of these methods has advantages and disadvantages, and is suitable for different hepatic segment resections. In clinical practice, it should be applied comprehensively under actual situation.

图1 S5切除,在S6侧循肝右静脉
图2 右半肝切除,断面显露肝中静脉
图3 左半肝切除,断面显露肝中静脉
图4 右半肝切除,结扎右肝蒂,循缺血线
图5 左半肝切除,分离、阻断左肝蒂
图6 ICG荧光染色:右半肝切除,反染法
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