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中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 224 -227. doi: 10.3877/cma.j.issn.1674-3946.2019.03.003

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腹腔镜肝右后区切除术的关键技术与策略
李相成1,(), 骆晨欢1, 孙瑜1, 李长贤1   
  1. 1. 210029 江苏,南京医科大学一附院肝胆中心
  • 收稿日期:2018-11-20 出版日期:2019-06-26
  • 通信作者: 李相成

Key strategies and techniques of laparoscopic right hepatectomy

Xiangcheng Li1,(), Chenhuan Luo1, Yu Sun1, Changxian Li1   

  1. 1. Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Jiangsu 210029, China
  • Received:2018-11-20 Published:2019-06-26
  • Corresponding author: Xiangcheng Li
  • About author:
    Corresponding author: Li Xiangcheng, Email:
  • Supported by:
    National Natural Science Foundation of China(81670570); Standardized Diagnosis and Treatment of Key Diseases in Social Development of Jiangsu Province(BE2016789); National Major Subjects on Infectious Diseases(2017ZX10203207-004-004)
引用本文:

李相成, 骆晨欢, 孙瑜, 李长贤. 腹腔镜肝右后区切除术的关键技术与策略[J]. 中华普外科手术学杂志(电子版), 2019, 13(03): 224-227.

Xiangcheng Li, Chenhuan Luo, Yu Sun, Changxian Li. Key strategies and techniques of laparoscopic right hepatectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(03): 224-227.

近年,腹腔镜肝切除术(LH)因其安全性、有效性、微创性等特点,在肝脏外科中飞速发展。腹腔镜肝右后叶切除由于其肝断面大、术野暴露困难、解剖结构复杂等特点,难度大、风险高。尤其是肝右后区临近膈面、位于腹腔深部、手术创面大和内结构复杂的特点,且右后叶临近右侧肾上腺、贴近下腔静脉,无疑增加了手术难度。本文主要论述腹腔镜肝右后叶切除的一些要点与策略。

In recent years, laparoscopic liver resection has been developed rapidly due to its features of safety, effectiveness, and minimal invasion. However, laparoscopic right posterior lobe resection is still difficult and risky due to extensive liver section, difficult exposure of surgical field, and complex anatomical structure. In particular, the right posterior region of the liver is adjacent to diaphragm, deep in abdominal cavity, with large surgical wound and complex internal structure, and the right posterior lobe is adjacent to the right adrenal gland and close to the inferior vena cava, which undoubtedly would increase the difficulty of surgery. This article proposed some strategies and techniques of laparoscopic right hepatectomy.

图1 右后肝区手术S6、7段肿瘤位置示意
图2 肝右后叶肿瘤位置示意
图3 传统的肝门解剖:Glisson鞘内解剖法
图4 右后叶切除后肝段面
图5 三维重建下肝右静脉示意
图6 镜下解剖肝短静脉
[1]
Komatsu S, Brustia R, Goumard C, et al.Laparoscopicversus open major hepatectomy for hepatocellular carcinoma: a matched pair analysis[J]. Surg Endosc, 2016, 30(5): 1965-1974.
[2]
季琳.腹腔镜右肝后叶切除术与开腹右肝后叶切除术的比较[D].杭州:浙江大学,2016:1-47.
[3]
Wakabayashi G, Cherqui D, Geller DA, et al.Recommendations for laparoscopic liver resection: a report from the second international consensus conference held inMorioka[J]. Ann Surg.2015, 261(4): 619-629.
[4]
Cherqui D, Husson E, Hammoud R, et al.Laparoscopic liver resections: a feasibility study in 30 patients[J]. Ann Surg, 2000, 232(6): 753-762.
[5]
陈孝平,张万广.腹腔镜肝癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(5):361-363.
[6]
沈锋.腹腔镜肝叶切除的纷争[J/CD].中华普外科手术学杂志(电子版),2018,12(5):368-371.
[7]
Ikeda T, Mano Y, Morita K, et al.Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection[J]. J Hepatobiliary Pancreat sci, 2013, 20(2): 145-150.
[8]
樊嘉,周俭,杨欣荣. 精准医学时代的肝癌外科治疗[J]. 中华消化外科杂志,2017,16(1):22-27.
[9]
花京文,黄长文,邹书兵,等. 自制改良式肝蒂阻断带在腹腔镜特殊部位肝切除中的应用[J/CD]. 中华肝脏外科手术学电子杂志,2016,5(3):144-147.
[10]
陈亚进,陈捷.腹腔镜右半肝切除术的技术要领--手术流程的标准化[J].中国实用外科杂志,2017,37(5):481-485.
[11]
Yamashita Y, Ikeda T, Kurihara T, et al. Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis: A Single-Center Experience over a 10-Year Period[J]. J Am Coll Surg, 2014, 219(6): 1117-1123.
[12]
Bodzin AS, Leiby BE, Ramirez CG, et al.Liver resection using cavitron ultrasonic surgical aspirator (CUSA) versus harmonic scalpel: a retrospective cohort study[J]. Int J Surg, 2014, 12(5): 500-503.
[13]
虞洪. 腹腔镜肝切除术并发症及防治[J]. 中国实用外科杂志,2017,37(5):577-579,585.
[14]
Imura S, Shimada M, Utsunomiya T, et al. Current status of laparoscopic liver surgery in Japan: Results of a multicenter Japanese experience[J]. Surg Today, 2014, 44(7): 1214-1219.
[15]
Troisi RI, Montalti R, Van Limmen JG, et al. Risk factors and management of conversions to an open approach in laparoscopic liver resection: Analysis of 265 consecutive cases[J]. HPB, 2014, 16(1): 75-82.
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