Gruner M, Balquet P, Lissitzky T, Lupold M
Chir Pediatr. 1985;26(2):77-80.
Intraoperative hemorrhage during hepatic veins approach or during liver parenchyma transsection is the major risk of liver resection for children. We report a technique for hepatic resection based upon facility of safe ligation or clamping of vessels and ductules on a bloodless cut surface during transsection. This technique limits risk of extensive hemorrhage or damage to residual parenchyma, without heavy procedures of anatomical resections. Particularities of liver tissues and capsula of children are used. Perfect hemostasis of the cut edge is obtained by mattress sutures on Silastic * straps performed after clamping with specially designed liver clamps. The 3 main interests of this clamping are detailed. 21 liver resections were performed on children ranging in age from 9 months to 11 years. There was one intra-operative death and one within 30 days. Total blood loss during procedure was about 1/3 blood mass.
肝静脉入路或肝实质横断过程中的术中出血是儿童肝切除的主要风险。我们报告一种肝切除技术，该技术基于在横断过程中能够安全结扎或钳夹无血切面上的血管和小胆管。此技术限制了广泛出血或损伤残余肝实质的风险，而无需进行复杂的解剖性切除操作。利用了儿童肝脏组织和肝包膜的特点。在用特制的肝钳钳夹后，通过在硅橡胶条上进行褥式缝合实现切缘的完美止血。详细阐述了这种钳夹的三个主要优点。对年龄在9个月至11岁的儿童进行了21例肝切除术。术中死亡1例，30天内死亡1例。手术过程中的总失血量约为三分之一血容量。
