Wang X M, Sun W D, Hu M H, Wang G N, Jiang Y Q, Fang X S, Han M
The Department of Hepatic-biliary Surgery of Yi Ji-shan Hospital , Wannan Medical College, Wuhu 241001, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 14;96(22):1746-9. doi: 10.3760/cma.j.issn.0376-2491.2016.22.007.
To investigate the clinical significance of the three-step approach in laparoscopic hemihepatectomy.
A total of 32 patients received laparoscopic hemihepatectomy with the three-step approach in Yijishan Hospital affiliated to Wannan Medical College between Aug 2013 and Oct 2015. All patients underwent thin slice CT scan and hemihepatectomy was imitated with the imagic explorer, preoperatively. The vessel distribution was observed at the section and the three-step approach was used in the hemihepatectomy. Pre- and post-operative data were collected and analyzed retrospectively.
The length of middle hepatic vein (MHV) was (59.1±12.9) mm and the number of branchs to the left and right lobe were 3.07±0.78 and 3.11±0.64 respectively. The distance between the first branch of MHV and the diaphragmatic surface was (28.07±3.74) mm and the distance between MHV and the visceral surface was (14.4±4.3) mm. The laparoscopic surgeries (left hemihepatectomy in 28 and right hemihepatectomy in 4) were performed successfully in all cases with the three-step approach, without any conversion to the open surgeries. The operation time was (165±42) min in left hemihepatectomy and (305±50) min in right hemihepatectomy. The intraoperative blood loss was (242±65) ml in left hemihepatectomy and (695±122)ml in right hemihepatectomy. All the patients recovered well without severe complications except for bile leakage in 3 patients who were cured with drainage. The postoperative hospital stay was (7.96±1.8) d.
the distribution of vessel is regional at the section of hemihepatectomy and the three-step approach based on this feature is safe and effective in laparoscopic hemihepatectomy, which can shorten the operation time and reduce the difficulty of operation.
探讨三步法在腹腔镜半肝切除术中的临床意义。
2013年8月至2015年10月期间，皖南医学院弋矶山医院共有32例患者接受了三步法腹腔镜半肝切除术。所有患者术前均接受薄层CT扫描，并使用图像浏览器模拟半肝切除术。在断面观察血管分布，并在半肝切除术中采用三步法。回顾性收集并分析术前和术后数据。
肝中静脉（MHV）长度为（59.1±12.9）mm，其至左、右叶的分支数分别为3.07±0.78和3.11±0.64。MHV第一分支与膈面的距离为（28.07±3.74）mm，MHV与脏面的距离为（14.4±4.3）mm。所有病例采用三步法均成功完成腹腔镜手术（左半肝切除术28例，右半肝切除术4例），无一例转为开放手术。左半肝切除术的手术时间为（165±42）分钟，右半肝切除术为（305±50）分钟。左半肝切除术的术中出血量为（242±6）5ml，右半肝切除术为（695±122）ml。除3例患者发生胆漏经引流治愈外，所有患者恢复良好，无严重并发症。术后住院时间为（7.96±1.8）天。
半肝切除断面血管分布具有区域性，基于此特征的三步法在腹腔镜半肝切除术中安全有效，可缩短手术时间，降低手术难度。
