Lazorthes F, Chiotasso P, Chevreau P, Materre J P, Roques J
Digestive Surgery Unit, Hôpital Purpan, Toulouse, France.
Surgery. 1993 Jan;113(1):103-8.
In 1985 Couinaud described an original technique for left hepatectomy. This technique is based on initial control of the left intrahepatic portal pedicle after wedge incision of the hepatic capsule is made and the hilar plate is lowered before the hepatic parenchyma is opened. The vascular and biliary pedicular elements are dissected concomitantly at a point where they are protected by and contained within a sheath emanating from the hepatic capsule. After elective clamping of the pedicle at this level is done, the territory to be removed becomes obvious by the change of color produced by ischemia, and bleeding is minimized preventively. Although Couinaud's technique concerned only one case of left hepatectomy, we confirmed the ease, safety, and reproducibility afforded by this technique in four left hepatectomies. Based on the same principles, this technique may be used for other types of hepatic resections, notably, left hepatectomy extended to segments 5 and 8 (trisegmentectomies). We report our experience with this technique in 15 cases of major hepatic resections.
1985年，库尼亚德描述了一种左肝切除术的原创技术。该技术基于在切开肝包膜楔形切口并降低肝门板后，首先控制左肝内门静脉蒂，然后再打开肝实质。血管和胆管蒂元件在由肝包膜发出的鞘所保护并包含它们的点处同时进行解剖。在该水平选择性夹闭门静脉蒂后，缺血产生的颜色变化使待切除区域变得明显，并且预防性地将出血降至最低。尽管库尼亚德的技术仅涉及一例左肝切除术，但我们在四例左肝切除术中证实了该技术的简便性、安全性和可重复性。基于相同的原则，该技术可用于其他类型的肝切除术，特别是扩展至第5和第8段的左肝切除术（三段切除术）。我们报告了我们在15例主要肝切除术中应用该技术的经验。
