Department of Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
J Gastrointest Surg. 2020 Oct;24(10):2395-2403. doi: 10.1007/s11605-020-04655-x. Epub 2020 May 29.
In laparoscopic proximal gastrectomy, the hepatic left lateral segment often obstructs the operative field of view, especially around the esophageal hiatus. Therefore, a safe retraction method is needed. The present study aimed to determine the effectiveness of inverting the hepatic left lateral segment in laparoscopic proximal gastrectomy.
This was a retrospective review of 81 consecutive patients who underwent laparoscopic proximal gastrectomy. Patients were divided into two groups, i.e., the Nathanson liver retractor group (n = 41) and hepatic left lateral segment inverting group (n = 40). The unedited video recordings of the procedures and the patients' medical records were reviewed and compared.
The hepatic left lateral segment inverting method provided a more satisfactory view of the operative fields and a wider working space around the esophageal hiatus than the Nathanson liver retractor. No intraoperative hepatic congestion and significantly improved postoperative liver enzyme elevations were observed with hepatic left lateral segment inverting method compared with the Nathanson liver retractor method.
In laparoscopic proximal gastrectomy, the hepatic left lateral segment inverting method appears to provide improvements in both the operative field of view and liver protection compared with the Nathanson liver retractor method.
在腹腔镜近端胃切除术中，肝左外侧叶常妨碍手术视野，特别是食管裂孔周围。因此，需要一种安全的牵开方法。本研究旨在确定腹腔镜近端胃切除术中翻转肝左外侧叶的效果。
这是一项对 81 例连续接受腹腔镜近端胃切除术的患者进行的回顾性研究。患者分为 Nathanson 肝拉钩组（n=41）和肝左外侧叶翻转组（n=40）。对手术的未经编辑的视频记录和患者的病历进行了回顾和比较。
肝左外侧叶翻转方法提供了更满意的手术视野，食管裂孔周围的工作空间更宽。与 Nathanson 肝拉钩组相比，肝左外侧叶翻转组术中肝淤血较轻，术后肝功能升高明显改善。
在腹腔镜近端胃切除术中，与 Nathanson 肝拉钩组相比，肝左外侧叶翻转方法似乎在手术视野和肝脏保护方面都有改善。
