腹腔镜肝切除术中肝中静脉和左肝静脉干的控制（附视频）。
Middle and left hepatic vein trunk control during laparoscopic liver resection (with video).
机构信息
Department of Hepato-Biliary Surgery and Transplantation, Centre Hépato-biliaire, Hopital Paul-Brousse, Université Paris-Sud, Villejuif, France.
出版信息
Surg Endosc. 2021 Mar;35(3):1476-1481. doi: 10.1007/s00464-020-08116-z. Epub 2021 Jan 4.
BACKGROUND
While inflow control can be easily applied by Pringle maneuver, outflow control of the left liver has not been formally described. We report here a safe and reproductible technique of middle and left hepatic veinous trunk control (MLHVC) before parenchymal transection during laparoscopic left hepatectomy.
METHODS
A retrospective review of laparoscopic liver resection was conducted from January 2013 to March 2018 from our prospective database. All cases of laparoscopic left hepatectomy (LLH) were included, and intra- and postoperative outcomes data collected. We collected cases where the middle and left hepatic vein trunk control has been attempted and clamping used, and we analyzed outcomes associated with this maneuver.
RESULTS
MLHVC was attempted in 28 cases (77.8) of the 36 LLH identify in a monocentric study. It was technically not feasible only in 3 cases (8.3%) and clamping applied in 15 cases (41.7%). No significant intraoperative unexpected event occurred.
CONCLUSION
We present here a technique for left liver outflow control that can be safely added to the armamentarium of laparoscopic liver surgery.
背景
虽然可以通过普雷令尔手法（Pringle maneuver）轻松地进行血流流入控制，但尚未正式描述左肝的血流流出控制。我们在此报告一种在腹腔镜左肝切除术中肝实质切开前安全且可重现的控制肝中静脉和左肝静脉干（middle and left hepatic veinous trunk control，MLHVC）的技术。
方法
对 2013 年 1 月至 2018 年 3 月期间来自我们前瞻性数据库的腹腔镜肝切除术进行回顾性审查。所有腹腔镜左肝切除术（laparoscopic left hepatectomy，LLH）病例均被纳入，并收集术中及术后的结果数据。我们收集了尝试控制肝中静脉和左肝静脉干并夹闭的病例，并分析了与该操作相关的结果。
结果
在单中心研究中确定的 36 例 LLH 中，有 28 例（77.8%）尝试了 MLHVC。仅在 3 例（8.3%）中技术上不可行，在 15 例（41.7%）中应用了夹闭。术中未发生任何意外的重大事件。
结论
我们在此提出了一种控制左肝流出的技术，可以安全地添加到腹腔镜肝手术的武器库中。
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