Hepatobiliary and Pancreatic Center & Liver Transplantation Center, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China.
Wuxi Medical School, Jiangnan University, Wuxi, Jiangsu Province, People's Republic of China.
BMC Gastroenterol. 2021 Mar 26;21(1):138. doi: 10.1186/s12876-021-01726-4.
Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH).
Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side.
The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2-4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05).
Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.
腹腔镜解剖性肝切除术（LAH）已逐渐成为常规手术。然而，由于尾状叶的存在，尤其是在右半肝切除术时，如何显露整个肝静脉并避免肝静脉撕裂仍然是一个挑战。我们采用背侧入路联合 Glissonian 入路行腹腔镜右半肝解剖性切除术（LRAH）。
回顾性分析 2017 年 1 月至 2018 年 11 月接受 LRAH 的 20 例患者。其中腹腔镜右半肝切除术（LRH）7 例（LRH 组），腹腔镜右后叶切除术（LRPH）7 例（LRPH 组），腹腔镜肝 7 段切除术（LS7 组）6 例。首先通过背侧入路切断尾状叶的腔静脉旁部分，可安全地从根部显露相应的主要肝静脉及其周围分支。由于沿主要肝静脉主干显露，剩余肝实质可迅速从背侧向头侧切断。
患者年龄 53.8 岁，男∶女为 8∶12。中位手术时间 306.0±58.2min，估计出血量 412.5±255.4ml。术后平均住院时间 10.2 天。平均阻断时间 64.8±27.7min。5 例患者输注 2-4U 红细胞。2 例患者出现短暂肝功能异常，1 例患者出现胸腔积液。无患者中转开腹。LRH、LRPH 和 LS7 组的手术时间、出血量、阻断时间和术后住院时间差异均无统计学意义（P＞0.05）。
背侧入路联合 Glissonian 入路行右半肝解剖性肝切除术是安全有效的。
