Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
J Gastrointest Surg. 2019 May;23(5):1084-1085. doi: 10.1007/s11605-018-4051-z. Epub 2019 Jan 25.
Laparoscopic hepatectomy for segment (S) 7 is classified as one of the most difficult procedures to perform. Here, we report a standardized method with the caudate lobe first approach which may benefit such difficult procedures.
A 76-year-old woman was diagnosed with multiple liver metastases after sigmoid colon cancer resection. Her liver function was normal. Abdominal CT showed multiple small tumors located in S3 (two), S7 (two), and S8 (two).
After partial resection of S3, the right lobe was fully mobilized. The caudate lobe was first divided at the midline from the caudal side parallel to the ventral central line of the inferior vena cava, and the caudate process was detached from the posterior Glissonean pedicle. Then, the S7 Glissonean branch was exposed. After transecting it, the demarcation line was secured. The root of the right hepatic vein (RHV) was exposed by further transection of the caudate lobe. The superficial tissue was divided using ultrasonic shears, while the deeper tissue was divided using cavitron ultrasonic surgical aspirator. The main trunk of the RHV was continuously exposed from the caudodorsal side, transecting the S7 branches. Between the exposed main trunk of the RHV and the cutting line in the ventral liver surface, which had been marked on the left of the tumor in the dorsal part of S8, the liver parenchyma was divided, securing the surgical margin for all 4 tumors in S7 and S8. Specimens were placed into a retrieval bag and removed from the umbilicus incision. Operation time was 341 min, and estimated blood loss was 200 g. Metastatic adenocarcinoma was confirmed by postoperative pathological diagnosis. The postoperative course was uneventful.
The caudate lobe first approach in laparoscopic hepatectomy for S7 is feasible and can benefit anatomical resection in such procedures.
腹腔镜肝切除术治疗 S7 段被认为是难度较大的手术之一。本文报道了一种采用尾叶入路的标准化方法，可能有助于此类困难手术的解剖性切除。
一名 76 岁女性因乙状结肠癌切除术后诊断为多处肝转移。其肝功能正常。腹部 CT 显示多个小肿瘤位于 S3（两个）、S7（两个）和 S8（两个）。
在部分切除 S3 后，充分游离右叶。沿下腔静脉腹正中线下行从中线向尾侧在肝尾叶作正中劈开，从肝尾叶后Glisson 蒂游离尾叶。然后显露 S7 的 Glisson 蒂分支，离断后确定肝断面。进一步离断肝尾叶显露右肝静脉（RHV）根部，用超声刀离断浅层组织，用 Cavitron 超声手术吸引器离断深层组织。继续从尾侧向头侧显露 RHV 主干，离断 S7 分支。在已标记的肿瘤背侧 S8 左叶的肝表面腹侧切开线与 RHV 暴露主干之间，肝实质离断，确保 S7 和 S8 的 4 个肿瘤均获得安全切缘。标本装入取物袋，经脐部切口取出。手术时间 341 分钟，估计出血量 200 克。术后病理诊断为转移性腺癌。术后过程顺利。
腹腔镜肝切除术治疗 S7 段时采用尾叶入路是可行的，有利于此类手术的解剖性切除。
