Nanashima Atsushi, Tobinaga Syuuichi, Abo Takafumi, Nonaka Takashi, Hidaka Shigekazu, Takeshita Hiroaki, Sawai Terumitsu, Nagayasu Takeshi
Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Hepatogastroenterology. 2012 Jul-Aug;59(117):1583-5. doi: 10.5754/hge10137.
To achieve complete extended right hepatectomy or trisectionectomy for a bismuth type IV hilar bile duct carcinoma, we propose the application of Belghiti's liver hanging maneuver (LHM) using a small nasogastric tube. This small nasogastric tube was placed in the cut plane: the top of the tube was placed between the hepatic veins. The tube was placed along the border between the left lateral sector and Spiegel's caudate lobe and the bottom of the tube was placed at the left side of the umbilical Glissonian pedicle. Hepatic parenchyma was transected using a vascular sealing device. Hepatic transection was always targeted to the tube and, eventually, a cut line of left hepatic ducts remained. We report the case of a 76-year-old female and an 83-year-old female with widely extended hilar bile duct carcinomas showing Bismuth type IV. Applying the modified LHM for extended right hepatectomy, the cut planes were easily and adequately obtained in patients with hilar bile duct carcinoma.
为实现对IV型肝门部胆管癌进行完整的扩大右肝切除术或三段切除术，我们建议使用一根小鼻胃管应用贝尔吉蒂肝脏悬吊法（LHM）。这根小鼻胃管置于切面：管的顶端置于肝静脉之间。管子沿着左外叶与斯皮格尔尾状叶之间的边界放置，管的底部置于脐部肝蒂左侧。使用血管封闭装置横断肝实质。肝实质横断始终以该管为目标，最终留下左肝管的切割线。我们报告了1例76岁女性和1例83岁女性患有广泛浸润的IV型肝门部胆管癌的病例。对扩大右肝切除术应用改良的LHM，在肝门部胆管癌患者中能够轻松且充分地获得切面。
