腹腔镜解剖性肝切除手术切面确定原则

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。

Principles for the determination of surgical plane in laparoscopic anatomic hepatectomy

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.