Kim Sungho, Han Ho-Seong, Sham Jonathan G, Yoon Yoo-Seok, Cho Jai Young
Department of Surgery, Korea University Medical Center Ansan Hospital, Ansan, Republic of Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Surg Oncol. 2019 Mar;28:158. doi: 10.1016/j.suronc.2019.01.004. Epub 2019 Jan 8.
Laparoscopic anatomical liver resection for posterosuperior lesions is challenging [1,2] A technique of anatomical liver resection with intrahepatic Glissonian approach in open surgery has been published [3]. However, few articles report this technique via the laparoscopic approach [4]. We report a case of laparoscopic anatomical S7 segmentectomy using the Glissonian pedicle approach.
A 76-year-old male was admitted for an incidentally detected hepatic mass in segment 7 (S7). Abdominal computed tomography (CT) showed a 5.5 cm solitary tumor. First, the major Glissonian pedicle of the right posterior section was dissected, followed by hepatic parenchymal dissection peripherally until the branches of the Glissonian pedicles of segment 6 and 7 were reached. The S7 Glissonian pedicle was temporarily clamped to confirm demarcation. Dissection was then performed until the right hepatic vein (RHV) was exposed. Further dissection was then continued along the RHV, up to its root.
Operative time was 330 minutes. The estimated intraoperative blood loss was 300 mL without a requirement for intraoperative transfusion. On postoperative day 4, the abdominal CT was performed, which revealed no abnormal findings. The patient was discharged on postoperative day 5 without any complications. Pathologic findings demonstrated a 5.2 × 3.8 × 3.1 cm hepatocellular carcinoma (pT1b) with a 2.8-cm tumor-free resection margin.
Laparoscopic anatomical S7 segmentectomy via the intrahepatic Glissonian approach is a technically demanding procedure and should be adopted for selected patients. However, this technique is feasible with careful dissection and control of the intrahepatic Glissonian pedicle.
腹腔镜下对肝后上部病变进行解剖性肝切除具有挑战性[1,2]。一种在开放手术中采用肝内Glisson蒂入路的解剖性肝切除技术已被发表[3]。然而，很少有文章报道通过腹腔镜入路实施该技术[4]。我们报告一例采用Glisson蒂入路的腹腔镜解剖性S7段切除术。
一名76岁男性因偶然发现肝脏第7段（S7）有肿块入院。腹部计算机断层扫描（CT）显示一个5.5厘米的孤立肿瘤。首先，解剖右后叶的主要Glisson蒂，然后从周边进行肝实质解剖，直至到达第6和第7段Glisson蒂的分支。暂时夹闭S7 Glisson蒂以确认界限。然后进行解剖，直至暴露右肝静脉（RHV）。接着沿RHV继续进一步解剖，直至其根部。
手术时间为330分钟。估计术中出血量为300毫升，无需术中输血。术后第4天进行腹部CT检查，未发现异常。患者术后第5天出院，无任何并发症。病理结果显示为一个5.2×3.8×3.1厘米的肝细胞癌（pT1b），切缘无肿瘤，宽度为2.8厘米。
通过肝内Glisson入路进行腹腔镜解剖性S7段切除术是一项技术要求较高的手术，应仅适用于特定患者。然而，通过仔细解剖和控制肝内Glisson蒂，该技术是可行的。
