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;28:222. doi: 10.1016/j.suronc.2019.01.014. Epub 2019 Feb 1.
In an attempt to preserve hepatic volume in cases of severe cirrhosis, isolated resection of segment 3 (Sg3) may be beneficial [1-3]. We describe a laparoscopic anatomical Sg3 segmentectomy via an extrahepatic Glissonian approach.
First, the falciform and coronary ligament were dissected. The Glissonian pedicle to Sg3 was isolated via meticulous dissection with the laparoscopic CUSA and suction catheter. After temporary occlusion, the ischemic margin of Sg3 was confirmed and the transection was performed from the medial and lateral aspects of Sg3. After the transection planes meet, hepatic venous and portal pedicle branches are controlled, and ultimately the main s3 Glissonian pedicle is ligated.
Operative time was 175 minutes and the estimated intraoperative blood loss was 30 mL. On postoperative day 3, the patient was discharged without any complications. Pathologic findings demonstrated a 2.1 × 1.5 × 1.0 cm hepatocellular carcinoma (pT2) with a 0.3 cm tumor-free resection margin.
The laparoscopic anatomic Sg3 segmentectomy is a feasible and safe procedure for hepatocellular carcinoma. This approach may be beneficial in cases where hepatic parenchymal preservation is desired.
为了在严重肝硬化病例中保留肝脏体积，单独切除肝段3（Sg3）可能是有益的[1-3]。我们描述了一种通过肝外Glissonian入路的腹腔镜解剖性Sg3肝段切除术。
首先，解剖镰状韧带和冠状韧带。通过使用腹腔镜CUSA和吸引导管进行细致解剖，分离出至Sg3的Glissonian蒂。在临时阻断后，确认Sg3的缺血边缘，并从Sg3的内侧和外侧进行横断。横断平面会合后，控制肝静脉和门静脉蒂分支，最终结扎S3的主要Glissonian蒂。
手术时间为175分钟，估计术中出血量为30毫升。术后第3天，患者无任何并发症出院。病理结果显示为一个2.1×1.5×1.0厘米的肝细胞癌（pT2），切缘无肿瘤，宽度为0.3厘米。
腹腔镜解剖性Sg3肝段切除术对于肝细胞癌是一种可行且安全的手术。这种方法在需要保留肝实质的病例中可能是有益的。
