腹腔镜肝右后区切除术的关键技术与策略
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摘要
近年,腹腔镜肝切除术(LH)因其安全性、有效性、微创性等特点,在肝脏外科中飞速发展。腹腔镜肝右后叶切除由于其肝断面大、术野暴露困难、解剖结构复杂等特点,难度大、风险高。尤其是肝右后区临近膈面、位于腹腔深部、手术创面大和内结构复杂的特点,且右后叶临近右侧肾上腺、贴近下腔静脉,无疑增加了手术难度。本文主要论述腹腔镜肝右后叶切除的一些要点与策略。
In recent years, laparoscopic liver resection has been developed rapidly due to its features of safety, effectiveness, and minimal invasion. However, laparoscopic right posterior lobe resection is still difficult and risky due to extensive liver section, difficult exposure of surgical field, and complex anatomical structure. In particular, the right posterior region of the liver is adjacent to diaphragm, deep in abdominal cavity, with large surgical wound and complex internal structure, and the right posterior lobe is adjacent to the right adrenal gland and close to the inferior vena cava, which undoubtedly would increase the difficulty of surgery. This article proposed some strategies and techniques of laparoscopic right hepatectomy.
In recent years, laparoscopic liver resection has been developed rapidly due to its features of safety, effectiveness, and minimal invasion. However, laparoscopic right posterior lobe resection is still difficult and risky due to extensive liver section, difficult exposure of surgical field, and complex anatomical structure. In particular, the right posterior region of the liver is adjacent to diaphragm, deep in abdominal cavity, with large surgical wound and complex internal structure, and the right posterior lobe is adjacent to the right adrenal gland and close to the inferior vena cava, which undoubtedly would increase the difficulty of surgery. This article proposed some strategies and techniques of laparoscopic right hepatectomy.
引文
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[9] 花京文,黄长文,邹书兵,等.自制改良式肝蒂阻断带在腹腔镜特殊部位肝切除中的应用[J/CD].中华肝脏外科手术学电子杂志,2016,5(3):144-147.
[10] 陈亚进,陈捷.腹腔镜右半肝切除术的技术要领--手术流程的标准化[J].中国实用外科杂志,2017,37(5):481-485.
[11] Yamashita Y,Ikeda T,Kurihara T,et al.Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis:A Single-Center Experience over a 10-Year Period[J].J Am Coll Surg,2014,219(6):1117-1123.
[12] Bodzin AS,Leiby BE,Ramirez CG,et al.Liver resection using cavitron ultrasonic surgical aspirator (CUSA) versus harmonic scalpel:a retrospective cohort study[J].Int J Surg,2014,12(5):500-503.
[13] 虞洪.腹腔镜肝切除术并发症及防治[J].中国实用外科杂志,2017,37(5):577-579,585.
[14] Imura S,Shimada M,Utsunomiya T,et al.Current status of laparoscopic liver surgery in Japan:Results of a multicenter Japanese experience[J].Surg Today,2014,44(7):1214-1219.
[15] Troisi RI,Montalti R,Van Limmen JG,et al.Risk factors and management of conversions to an open approach in laparoscopic liver resection:Analysis of 265 consecutive cases[J].HPB,2014,16(1):75-82.
[2] 季琳.腹腔镜右肝后叶切除术与开腹右肝后叶切除术的比较[D].杭州:浙江大学,2016:1-47.
[3] Wakabayashi G,Cherqui D,Geller DA,et al.Recommendations for laparoscopic liver resection:a report from the second international consensus conference held inMorioka[J].Ann Surg.2015,261(4):619-629.
[4] Cherqui D,Husson E,Hammoud R,et al.Laparoscopic liver resections:a feasibility study in 30 patients[J].Ann Surg,2000,232(6):753-762.
[5] 陈孝平,张万广.腹腔镜肝癌根治术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(5):361-363.
[6] 沈锋.腹腔镜肝叶切除的纷争[J/CD].中华普外科手术学杂志(电子版),2018,12(5):368-371.
[7] Ikeda T,Mano Y,Morita K,et al.Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection[J].J Hepatobiliary Pancreat sci,2013,20(2):145-150.
[8] 樊嘉,周俭,杨欣荣.精准医学时代的肝癌外科治疗[J].中华消化外科杂志,2017,16(1):22-27.
[9] 花京文,黄长文,邹书兵,等.自制改良式肝蒂阻断带在腹腔镜特殊部位肝切除中的应用[J/CD].中华肝脏外科手术学电子杂志,2016,5(3):144-147.
[10] 陈亚进,陈捷.腹腔镜右半肝切除术的技术要领--手术流程的标准化[J].中国实用外科杂志,2017,37(5):481-485.
[11] Yamashita Y,Ikeda T,Kurihara T,et al.Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis:A Single-Center Experience over a 10-Year Period[J].J Am Coll Surg,2014,219(6):1117-1123.
[12] Bodzin AS,Leiby BE,Ramirez CG,et al.Liver resection using cavitron ultrasonic surgical aspirator (CUSA) versus harmonic scalpel:a retrospective cohort study[J].Int J Surg,2014,12(5):500-503.
[13] 虞洪.腹腔镜肝切除术并发症及防治[J].中国实用外科杂志,2017,37(5):577-579,585.
[14] Imura S,Shimada M,Utsunomiya T,et al.Current status of laparoscopic liver surgery in Japan:Results of a multicenter Japanese experience[J].Surg Today,2014,44(7):1214-1219.
[15] Troisi RI,Montalti R,Van Limmen JG,et al.Risk factors and management of conversions to an open approach in laparoscopic liver resection:Analysis of 265 consecutive cases[J].HPB,2014,16(1):75-82.