腹腔镜下不解剖肝门Endo-GIA离断左肝蒂行左半肝切除术

腹腔镜肝切除术已成为当今肝外科发展的潮流,我科室2013年开展腹腔镜切除以来,已完成130例腹腔镜肝切除,约占肝脏手术的1/3。腔镜下控制出血的方法大致分为:1.病侧肝入肝血流暂时阻断法;2.全肝入肝血流暂时阻断法;3.全肝血流阻断法。此处病例采用不解剖肝门预处理病侧入肝血流,选用美敦力创新外科Endo GIA(白色,45 mm)一次性插入左叶肝实质离断左肝蒂,再行左半肝实质离断,该方法具有手术时间短,出血少的优点.但术前应结合CT增强扫描,计算机三维重建排除门静脉,肝动脉及胆道变异情况。

Laparoscopic left hemi-hepatectomy surgery by using of Endo-GIA to pre-cut of left hepatic blood vessels

Laparoscopic hepatectomy is the development trend of hepatic surgery .About 130 cases of laparoscopic hepatectomy have been performed in our center since 2013, around 30% of all liver surgeries.By far, the method of bleeding control include:(1) hepatic vascular exclusion for diseased side;(2)total hepatic vascular inflow exclusion (Pringle maneuver);(3)total hepatic inflow and outflow vascular exclusion ( Pringle maneuver combined with intrahepatic IVC exclusion ) . The case showed here was performed with left hemi-hepatectomy surgery by using of Endo GIA to pre-cut of left hepatic blood vessels without any dissection of hepatic hilum .But it is necessary to do preoperational evaluation by CT-3D graph to exclude any variations of blood vessels and bile ducts .This method is simple and good control of bleeding .