Department of Surgery, Eulji University College of Medicine, Daejeon, Republic of Korea.
Department of Surgery, Eulji University Hospital, Dunsan 2(i)-dong, Daejeon, Seo-gu, Republic of Korea.
J Gastrointest Surg. 2020 Oct;24(10):2393-2394. doi: 10.1007/s11605-020-04637-z. Epub 2020 May 29.
Anatomical segmentectomy is a technically challenging procedure because tertiary portal pedicles are multiple, variable, and deep inside the liver. Anatomical segmentectomy can be performed using the transfissural Glissonean approach through the opening main portal fissure or umbilical fissure. We present laparoscopic anatomical resection of segment 4b using the transfissural Glissonean approach.
A 67-year-old man was referred for treatment of single nodular mass in segment 4b. The surgical procedure involved the following steps: (1) Opening of the umbilical fissure along the umbilical fissure vein (2) Dissection of Glissonean pedicle 4b (3) Identification of ischemic territory of segment 4b (4) Right-side parenchymal transection along the ischemic line.
The operative time was 230 min, and the estimated blood loss was 100 mL. The final histopathological diagnosis was hepatocellular carcinoma. The tumor size was 30 mm and the resection margin was 25 mm. The patient had an uneventful postoperative recovery, and he was discharged on postoperative day 6.
The transfissural Glissonean approach for laparoscopic anatomic resection of segment 4 b is a feasible and effective technique. The opening of the umbilical fissure allows the surgeon to dissect the target portal pedicles of segment 4b directly.
解剖性节段切除术是一项技术上具有挑战性的手术，因为三级门脉蒂有多支、多变且位于肝脏深部。解剖性节段切除术可通过开放主门脉裂或脐裂的经裂 Glissonean 入路进行。我们介绍使用经裂 Glissonean 入路行腹腔镜解剖性 4b 段切除术。
一名 67 岁男性因单发结节位于 4b 段而就诊。手术步骤如下：（1）沿脐裂静脉切开脐裂；（2）解剖 4b 段 Glissonean 蒂；（3）确定 4b 段缺血区域；（4）沿缺血线行右侧肝实质离断。
手术时间为 230 分钟，估计出血量为 100 毫升。最终组织病理学诊断为肝细胞癌。肿瘤大小为 30 毫米，切缘为 25 毫米。患者术后恢复顺利，术后第 6 天出院。
经裂 Glissonean 入路行腹腔镜解剖性 4b 段切除术是一种可行且有效的技术。切开脐裂可使术者直接解剖 4b 段的目标门脉蒂。
