Department of Liver Surgery, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China.
J Gastrointest Surg. 2023 Jun;27(6):1290-1291. doi: 10.1007/s11605-023-05623-x. Epub 2023 Mar 6.
Hepatic hemangioma has been one of the absolute indications of laparoscopic hepatectomy (LH). However, the risk of catastrophic intraoperative bleeding and the difficulty to control it make the laparoscopic treatment of giant hepatic hemangioma (GHH) a technical challenge for hepatobiliary surgeons. Herein, we presented a video of LH for GHH using the involved intrahepatic anatomic markers approach.
A 22-year-old female was referred for treatment of an intractable GHH (18 cm), which involved the left hepatic pedicle, left hepatic vein (LHV), and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers on CT. The procedure was performed according to the following steps: (1) dissecting and ligating the left hepatic artery (LHA) and left portal vein (LPV) via intrafascial approach, respectively; (2) cutting the accessory LHA; (3) transecting parenchymal along the demarcation line in a caudal-to-cranial direction and exposing the involved caudal middle hepatic vein (MHV); (4) isolating and transecting the involved left hepatic duct; (5) preserving the integrity of involved MHV; (6) isolating and transecting the left hepatic vein (LHV) and splenic vein (SV); (7) mincing and extracting the specimen. This study was approved by the West China Hospital Ethics Committee and was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. All treatments were performed after obtaining written informed consent from the patients.
The operative time was 286 min, and blood loss during operation was 160 ml. This procedure ensured the integrity of MHV and maximized the residual functional hepatic volume. The histopathologic examination confirmed the hepatic cavernous hemangioma. The patient had an uneventful postoperative recovery and was discharged on the fifth day after operation.
LH using the involved intrahepatic anatomic markers approach is feasible and effective for intractable GHH. Its advantages lie in decreasing the risk of disastrous hemorrhage or open conversion rate while maximizing the postoperative functional hepatic reserve..
肝血管瘤一直是腹腔镜肝切除术（LH）的绝对适应证之一。然而，术中灾难性出血的风险及其难以控制使得肝胆外科医生对巨大肝血管瘤（GHH）的腹腔镜治疗成为一项技术挑战。在此，我们展示了一例使用受累肝内解剖标志物方法行 LH 治疗 GHH 的视频。
一名 22 岁女性因难治性 GHH（18cm）就诊，该肿瘤累及左肝蒂、左肝静脉（LHV）和中肝静脉（MHV），导致 CT 上无法看到上述肝内解剖标志物。手术按照以下步骤进行：（1）通过筋膜内入路分别解剖和结扎左肝动脉（LHA）和左门静脉（LPV）；（2）切断副 LHA；（3）沿尾到头方向的分界线切断肝实质，显露受累的尾侧中肝静脉（MHV）；（4）分离并切断受累的左肝管；（5）保留受累的 MHV 完整性；（6）分离并切断左肝静脉（LHV）和脾静脉（SV）；（7）切碎并取出标本。本研究经华西医院伦理委员会批准，并按照《赫尔辛基宣言》的伦理准则进行。所有治疗均在获得患者书面知情同意后进行。
手术时间为 286 分钟，术中出血量为 160ml。该手术确保了 MHV 的完整性，并最大限度地保留了剩余的功能性肝体积。组织病理学检查证实为肝海绵状血管瘤。患者术后恢复顺利，术后第 5 天出院。
使用受累肝内解剖标志物方法的 LH 治疗难治性 GHH 是可行且有效的。其优点在于降低灾难性出血或中转开腹的风险，同时最大限度地保留术后功能性肝储备。
