Laurenzi Andrea, Cherqui Daniel, Figueroa Rodrigo, Adam René, Vibert Eric, Sa Cunha Antonio
Hepato-Biliary Center, Paul Brousse Hospital, Villejuif, France.
Hepato-Biliary Center, Paul Brousse Hospital, Villejuif, France.
HPB (Oxford). 2018 Feb;20(2):128-131. doi: 10.1016/j.hpb.2017.05.013. Epub 2017 Nov 24.
Laparoscopic resection has gained a significant place in liver surgery. As in open liver resection, bleeding control during hepatic transection remains a major issue and it represents the main reason for conversion to laparotomy. Pringle maneuver (PM) remains the standard inflow occlusion technique and a specific step-by-step description of totally intracorporeal laparoscopic PM is described.
The technique includes placement of a tape around the hepatoduodenal which is then passed through a plastic drain. This creates a tourniquet that is locked with a heavy duty clip to allow intermittent use.
This technique has been used in over 400 cases over the past 15 years and has proved safe and efficient with no specific complications encountered. It has been used in in 97 of 170 cases (57%) in the past 4 years and its feasibility has been 97%. Its intracorporeal position does not require an additional trocar and does not interfere with the surgeons' view and operating technique. Cycles of clamping and unclamping can be performed in few seconds including in the emergency setting.
Totally laparoscopic PM is a simple, reproducible and inexpensive method of inflow occlusion during laparoscopic liver resection.
腹腔镜肝切除术在肝脏外科中占据了重要地位。与开放性肝切除术一样，肝实质离断过程中的出血控制仍然是一个主要问题，也是中转开腹的主要原因。Pringle手法（PM）仍然是标准的入肝血流阻断技术，本文描述了完全腹腔镜下PM的具体操作步骤。
该技术包括在肝十二指肠周围放置一条带子，然后将其穿过一个塑料引流管。这样就形成了一个止血带，用一个重型夹子固定，以便间歇性使用。
在过去15年中，该技术已应用于400多例患者，证明安全有效，未出现特殊并发症。在过去4年中，170例患者中有97例（57%）使用了该技术，其可行性为97%。其在体内的位置不需要额外的套管针，也不影响术者的视野和操作技术。包括在紧急情况下，夹闭和松开的操作可在几秒钟内完成。
完全腹腔镜下PM是腹腔镜肝切除术中一种简单、可重复且成本低廉的入肝血流阻断方法。
