Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Laboratory of Liver Transplantation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital of Sichuan University, Chengdu, China.
Ann Surg Oncol. 2022 May;29(5):2980-2981. doi: 10.1245/s10434-021-11221-5. Epub 2022 Jan 7.
Laparoscopic segmentectomy, which maximizes the preservation of the functional hepatic reserve and the possibility for future repeat hepatectomy while ensuring adequate surgical margin, is a feasible alternative to hemihepatectomy for hepatocellular carcinoma (HCC) (Vigano et al. in Ann Surg 270(5):842-851, 2019, Ishizawa et al. in Ann Surg 256(6):959-964, 2012). Herein, we present a video of laparoscopic segmentectomy IV for HCC using hepatic round ligament approach combined with fluorescent negative staining method.
A 44-year-old male with history of chronic hepatitis B virus (HBV) infection for 22 months was referred for treatment of a single HCC in segment IV. The procedure was performed according to the following steps: (1) lowering the hilar plate based on Laennec's capsule (Sugioka et al. in J Hepatobiliary Pancreat Sci 24(1):17-23, 2017) after cholecystectomy; (2) cutting the Glisson's pedicles to segment IV along the fissure for the round ligament; (3) the first parenchyma transection was along the falciform ligament, while cutting some deep pedicles to segment IV; (4) clamping the left Glisson's pedicle and using fluorescent negative staining method (Abo et al. in Eur J Surg Oncol 41(2):257-264, 2015, Funamizu et al. in J Hepatobiliary Pancreat Sci, 2021, Xu et al. in Surg Endosc 34(10):4683-4691, 2020); (5) the second parenchyma transection was performed along the boundary of negative fluorescence region to expose the middle hepatic vein (MHV) using a combination of cranial and caudal approaches.
The operative time was 190 min, and blood loss during operation was 80 mL. The histopathologic examination showed a solitary HCC, 2.5 cm in diameter, with negative surgical margin and no microvascular invasion. The patient had an uneventful postoperative recovery and was discharged on postoperative day 5.
The round ligament approach combined with fluorescent negative staining method for laparoscopic anatomic segmentectomy IV is a feasible and effective technique.
腹腔镜肝段切除术在保证足够手术切缘的同时最大限度地保留了功能性肝储备和未来再次肝切除的可能性，是肝细胞癌（HCC）半肝切除术的可行替代方法（Vigano 等人，Ann Surg 270(5):842-851, 2019；Ishizawa 等人，Ann Surg 256(6):959-964, 2012）。在此，我们展示了一种使用肝圆韧带入路联合荧光负染法的腹腔镜肝段切除术 IV 治疗 HCC 的视频。
一名 44 岁男性，慢性乙型肝炎病毒（HBV）感染病史 22 个月，因单发 HCC 就诊于我院，拟行手术治疗。该手术按以下步骤进行：（1）在胆囊切除术后，根据 Laennec 囊降低肝门平面（Sugioka 等人，J Hepatobiliary Pancreat Sci 24(1):17-23, 2017）；（2）沿圆韧带裂隙切开进入段 IV 的 Glisson 蒂；（3）第一刀肝实质切开线沿着镰状韧带，同时切断一些进入段 IV 的深部蒂；（4）夹闭左 Glisson 蒂，使用荧光负染法（Abo 等人，Eur J Surg Oncol 41(2):257-264, 2015；Funamizu 等人，J Hepatobiliary Pancreat Sci，2021；Xu 等人，Surg Endosc 34(10):4683-4691, 2020）；（5）第二刀肝实质切开线沿着负荧光区域的边界进行，使用头侧和尾侧联合入路显露中肝静脉（MHV）。
手术时间为 190 分钟，术中出血量 80 毫升。组织病理学检查显示单发 HCC，直径 2.5 厘米，切缘阴性，无微血管侵犯。患者术后恢复顺利，术后第 5 天出院。
腹腔镜解剖性肝段切除术 IV 采用肝圆韧带入路联合荧光负染法是一种可行且有效的技术。
