肝脏拖出在特殊部位肝外伤手术中的应用

目的总结肝脏拖出在8例特殊部位肝外伤手术中应用的经验。方法应用肝脏拖出实施第VII段或第VIII段、尾状叶等特殊部位肝外伤手术共8例,行间歇性肝门阻断。其中2例行挫裂伤下腔静脉壁修补,1例在第三肝门肝短静脉逐个结扎后,拖出翻转行尾状叶切除门静脉后壁裂伤修补。术中肝门阻断时间（55±21）min,出血量（2140±750）ml,手术时间（75±42）min。结果全组无手术死亡,手术过程顺利,术中暴露病变清晰,效果满意。结论应用肝脏拖出术,能解决特殊部位肝外伤的术野显露问题,从而为该部位外伤的处理提供良好的视野和空间。

The application of dragging out the liver from the abdomen in resection of special position of the liver trauma

Objective To summarize the experience of dragging out the liver from the abdomen in resection of special position of the liver trauma.Methods From 2003 to 2008,Caudate lobectomy、Ⅷ Segmentectomy of liver,right hepatectomy：including 1case with injury from caudate lobe and portal vein and 7cases with injury from segment Ⅷ of liver were performed in 8cases patients with dragging out the liver from abdomen.The mean intraoperative blood loss was（2140 ± 750） ml,meantime of vascular occlusion of inflow（55 ± 21） min and meantime of resection（75 ± 42） min.Results There was no operative death.The postoperative complicativewere right pleural effusion in 3cases and asites in 1.All patients were cure by dragging out the liver from the abdomen.Biliary fistula and bleeding did not occur after the operation.Conclusion Using dragging out the liver from the andomen technique.It is possible to precisely dissect the structure,therefore,caudate lobectomy,Ⅷ segmentectomy,right hepatectomy can be isolated from hepatic veins and IVC without any difficulty and the resection can be safely performed.