Shimahara Y, Yamamoto N, Kobayashi N, Yamaoka Y
First Department of Surgery, Ehime University School of Medicine, Japan.
Nihon Geka Hokan. 1996 Jan 1;65(1):13-21.
A simple procedure of right hepatic lobectomy for bulky liver tumors is proposed. The procedure is named "Anterior approach", which is characterized by transection of hepatic parenchyma without mobilization and rotation of the right hepatic lobe. The transection directly reaches the ventral surface of the retrohepatic inferior vena cava first at the portion of caudate process. The hepatic parenchymal transection proceeds from ventral to dorsal and from caudal to cranial. Several dorsal short hepatic veins are severed on the ventral surface of the IVC and the right hepatic vein is finally severed from inside. This method enables the minimization of operative stress and is especially useful for cases with a huge tumor in the right hepatic lobe which invades the diaphragm or thoraco-abdominal wall.
本文提出了一种针对巨大肝脏肿瘤的右肝叶切除术的简单手术方法。该手术方法被命名为“前入路”，其特点是在不游离和旋转右肝叶的情况下进行肝实质离断。肝实质离断首先在尾状突处直接到达肝后下腔静脉的腹侧面。肝实质离断从腹侧到背侧、从尾侧向头侧进行。在腔静脉腹侧面切断数条肝背短静脉，最后从内部切断右肝静脉。该方法能够将手术应激降至最低，尤其适用于右肝叶有巨大肿瘤并侵犯膈肌或胸腹壁的病例。
