Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China.
Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, China.
Hepatobiliary Pancreat Dis Int. 2018 Aug;17(4):316-322. doi: 10.1016/j.hbpd.2018.06.002. Epub 2018 Jun 25.
Laparoscopic anatomic hepatectomy remains challenging because of the complex interior structures of the liver. Our novel strategy includes the Glissonian approach and the major hepatic vein first, which serves to define the external and internal landmarks for laparoscopic anatomic hepatectomy.
Eleven cases underwent laparoscopic anatomic hepatectomy, including three right hepatectomies, three left hepatectomies, three right posterior hepatectomies, and two mesohepatectomies. The Glissonian approach was used to transect the hepatic pedicles as external demarcation. The major hepatic vein near the hepatic portal was exposed and served as the internal landmark for parenchymal transection. The liver parenchyma below and above the major hepatic vein was transected along the major hepatic vein. Fifty-nine subjects were used to compare the distance between the major hepatic vein and secondary Glisson pedicles among different liver diseases.
The average operative time was 327 min with an estimated blood loss of 554.55 mL. Only two patients received three units of packed red blood cells. The others recovered normally and were discharged on postoperative day 7. The distance between right posterior Glissonian pedicle and right hepatic vein was shorter in the patients with cirrhosis than that without cirrhosis, and this distance was even shorter in patients with hepatocellular carcinoma.
The Glissonian approach with the major hepatic vein first is easy and feasible for laparoscopic anatomic hepatectomy, especially in patients with hepatocellular carcinoma and cirrhosis.
由于肝脏内部结构复杂，腹腔镜解剖性肝切除术仍然具有挑战性。我们的新策略包括 Glissonian 入路和肝静脉优先，这有助于确定腹腔镜解剖性肝切除术的外部和内部标志。
11 例患者接受了腹腔镜解剖性肝切除术，包括 3 例右肝切除术、3 例左肝切除术、3 例右后叶肝切除术和 2 例中肝切除术。采用 Glissonian 入路切断肝蒂作为外部界限。显露肝门附近的肝静脉作为肝实质切开的内部标志。沿肝静脉切开肝静脉下方和上方的肝实质。对 59 例不同肝病患者肝静脉主干与次级 Glisson 蒂之间的距离进行比较。
平均手术时间为 327 分钟，估计失血量为 554.55 毫升。只有 2 例患者接受了 3 个单位的浓缩红细胞。其余患者均恢复正常，术后第 7 天出院。肝硬化患者的右后叶 Glissonian 蒂与肝静脉之间的距离比无肝硬化患者短，而肝癌患者的距离更短。
Glissonian 入路联合肝静脉优先法对于腹腔镜解剖性肝切除术是简单可行的，特别是在肝癌和肝硬化患者中。
