Cho Akihiro, Arita Seiji, Koike Naoto, Isaka Naohide, Kusume Kenichi, Okazumi Shinichi, Ochiai Takenori
Department of Surgery, Seirei Sakura Citizen Hospital, Japan.
Hepatogastroenterology. 2007 Mar;54(74):531-2.
Surgical techniques commonly used for controlling bleeding during major liver surgery are hepatic inflow occlusion (Pringle maneuver) or total hepatic vascular exclusion (THVE), which are effective procedures of diminishing intraoperative blood loss. However, it is difficult to control retrograde bleeding from the hepatic veins using Pringle maneuver and some patients do not tolerate hemodynamic changes caused by THVE. We isolated the left and middle hepatic veins separately using Arantius' ligament approach to these hepatic veins, and extrahepatic control of the relevant to the liver segment to be resected hepatic veins with inflow control by Glissonian pedicle clamping was successfully performed.
在肝脏大手术中，常用于控制出血的手术技术是肝血流阻断（Pringle手法）或全肝血管隔离（THVE），这两种方法是减少术中失血的有效手段。然而，使用Pringle手法很难控制来自肝静脉的逆行出血，并且一些患者无法耐受THVE引起的血流动力学变化。我们采用针对肝静脉的阿朗希乌斯韧带入路分别分离左、中肝静脉，并通过Glisson蒂夹闭对拟切除肝段相关肝静脉进行肝外控制并成功实现入流控制。
