Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Ann Surg Oncol. 2020 Jul;27(7):2381-2386. doi: 10.1245/s10434-020-08306-y. Epub 2020 Mar 9.
Left trisectionectomy [(LT) resection of segments 2, 3, 4, 5, 8, and 1] for perihilar cholangiocarcinoma is still a challenging procedure with high postoperative morbidity and mortality. To perform LT safely, the liver transection-first approach was developed. In this approach, liver transection is started without dividing the right anterior hepatic artery (RAHA) and right anterior portal vein (RAPV). After the completion of liver transection, the RAHA and RAPV, which run into the future resected liver, can be easily identified and divided under the wide surgical field at the hepatic hilus. The liver transection-first approach appears to be safer than the conventional LT, leading to less postoperative morbidity and mortality.
左三叶切除术（LT 切除 2、3、4、5、8 和 1 段）治疗肝门部胆管癌仍然是一种具有高术后发病率和死亡率的挑战性手术。为了安全地进行 LT，开发了肝先离断法。在这种方法中，肝离断术在不分离右前肝动脉（RAHA）和右前门静脉（RAPV）的情况下进行。完成肝离断后，位于未来切除肝脏内的 RAHA 和 RAPV 可以在肝门部宽阔的手术野下很容易地识别和分离。肝先离断法似乎比传统的 LT 更安全，导致术后发病率和死亡率更低。
