肝后隧道的建立与绕肝带的使用在高难度肝切除术中的作用

目的 评价通过下腔静脉前间隙安放绕肝带在高难度肝切除中的作用及意义。方法 钝性分离肝后下腔静脉前间隙而形成肝后隧道。通过该隧道安放弹力带,环绕肝脏在其表面穿过止血板。拉紧绕肝带即产生局部压迫止血作用,用以替代肝门阻断实施7例高难度肝切除术。结果 7例均成功安放绕肝带并行第Ⅷ段、左半肝、右半肝、右三叶 全尾叶等切除术,未发生与本操作有关的并发症。结论 下腔静脉前间隙安放绕肝带替代肝门和全肝血流阻断不仅在技术上可行,而且具有适应证广、血流动力学影响小的优点,尤其适合于高难度肝切除及活体肝移植时供肝的切取。

The role and significance of retrohepatic tunnel and the liver hanging tape passed through the tunnel in difficult hepatectomies

OBJECTIVE: To explore the role and significance of liver hanging tape passed through the retrohepatic tunnel developed by dissecting the tissue plane between anterior surface of the inferior vena cava (IVC) and caudate lobe, in order to be substitute for control of in- and out-flow blood vessels in difficult hepatectomies. METHODS: Retrohepatic tunnel was developed by dissecting the anterior surface of the retrohepatic portion of the IVC, 7 difficult hepatectomies were performed with the use of liver hanging tape and hemostatic plate. RESULTS: Liver hanging tape was placed successfully in 7 cases. VIII segmentectomy, right hemihepatectomy, left hemihepatectomy and right trilobectomy plus complete caudate lobectomy were performed, there was no complication related to this maneuver. CONCLUSION: It is feasible for placing liver hanging tape through the retrohepatic tunnel. In addition, it has extensive indications and minimal influence on hemodynamic response. It is a better way for the difficult hepatectomy and for harvesting the liver graft in living related liver transplantation.