腹腔镜下右半肝切除的技术要点

Main points of technique for laparoscopic right hemihepatectomy

目前,腹腔镜肝切除已被广泛应用于肝脏良恶性疾病的治疗中,然而腹腔镜右半肝切除仍是一项高难度、高风险的技术,在全球范围内仍未广泛开展。笔者结合成功开展腹腔镜右半肝切除的经验和最新的文献报道,对该手术的要点,包括麻醉要求、手术室配置、手术器械准备等,及肝脏游离、入肝血流和出肝血流的阻断、肝脏实质离断等具体手术技巧做一总结;并对术中出血这一最常见的并发症的预防和处理措施做一详细探讨。

Recently, laparoscopic hepatectomy has been increasing widely used for hepatic benign and malignant diseases. However laparoscopie right hemihepatectomy is still regarded as a complicated and high-risk technique, and yet has not been widely applied in the world. In the article, it introduced the key points of the procedure, including anesthesia requirements, operating room arrangement and instruments preparation. Meanwhile, it described the technique details and skills step by step, including liver motivation, hepatic inflow and outflow occlusion and parenchyma dissection of the procedure. In addition, the prevention and management of intraoperative massive bleedinghave also been discussed.