Sadamori Hiroshi, Matsuda Hiroaki, Shinoura Susumu, Umeda Yuzo, Yoshida Ryuichi, Sato Daisuke, Utsumi Hisashi, Ohnishi Teppei, Yagi Takahito
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1511-5.
In this article, we describe a safe technique and the outcome of anatomical subsegmentectomies of segments 2 and 3 in patients with chronic liver disease. In cases of subsegmentectomy of segment 2, Arantius duct is transected at the side of umbilical portion and then the liver parenchyma located just above the root of the glissonean pedicle feeding segment 2 is transected. This procedure allows to encircle and dissect the root of the glissonean pedicle feeding segment 2 safely even in cirrhotic patients. After marking the discolored area on the liver surface, parenchymal transection between segment 2 and segment 3 was performed. In cases of subsegmentectomy of segment 3, the root of the glissonean pedicle feeding subsegment 3 is encircled and dissected from the ventral side of the umbilical portion before liver parenchymal resection. Using our technique, we performed subsegmentectomies of segment 3 in four hepatocellular carcinoma (HCC) patients and of segment 2 in two HCC patients. There was no postoperative liver failure and remnant liver function was adequate in all six of our cases. Although three of the six patients had HCC recurrence after hepatectomy, various and multiple treatments for HCC recurrence could be performed in these three patients. Subsegmentectomies for HCC located in the lateral segment were performed safely and could contribute to preservation of remnant liver function.
在本文中，我们描述了一种安全技术以及慢性肝病患者肝段2和肝段3的解剖性亚段切除术的结果。在肝段2亚段切除术中，在脐部一侧横断阿兰特斯导管，然后横断位于滋养肝段2的肝蒂根部上方的肝实质。即使在肝硬化患者中，该操作也能安全地环绕并解剖滋养肝段2的肝蒂根部。在标记肝脏表面的变色区域后，进行肝段2和肝段3之间的实质横断。在肝段3亚段切除术中，在肝实质切除前，从脐部腹侧环绕并解剖滋养亚段3的肝蒂根部。使用我们的技术，我们对4例肝细胞癌（HCC）患者进行了肝段3亚段切除术，对2例HCC患者进行了肝段2亚段切除术。我们的所有6例患者均未发生术后肝衰竭，残余肝功能充足。虽然6例患者中有3例在肝切除术后出现HCC复发，但这3例患者均可进行多种针对HCC复发的治疗。位于外侧段的HCC的亚段切除术得以安全实施，并且有助于保留残余肝功能。
