陈氏绕肝提拉法在巨大肿瘤右半肝切除术中的应用

Application of Chen＇s liver hanging maneuver in right hemihepatectomy for huge liver tumor

目的 评价陈氏绕肝提拉法在右半肝切除术中的应用价值.方法 右肝巨大肿瘤行右半肝切除时,采取陈氏绕肝提拉法经下腔静脉右侧放置提肝带,离断肝实质的过程中通过牵拉提肝带辅助肝切除.结果 全组共32例右肝巨大肿瘤患者行右半肝切除术,其中前入路肝切除15例,经典入路17例.术中均成功放置提肝带,放置和牵拉过程中无肝短静脉撕裂和大出血等相关并发症.32例肝切除术的肝实质离断时间约25～45 min,肝门阻断时间约20～32 min,术中出血量300～1 300ml.所有患者无围手术期死亡.结论 陈氏绕肝提拉法有助于右半肝切除术中手术野的显露,缩短肝实质离断时间,减少肝实质离断过程中的出血;且其操作简单、使用安全、适用范围广泛.

Objective To evaluate the effect of Chen＇s liver hanging maneuver on improving the operation safety of right hemihepatectomy for huge liver tumor.Methods During right hemihepatecto my,a retrohepatic tunnel along the right side of the IVC was developed according to Chen＇s method.Right hepatectomy was performed with liver hanging maneuver method via a tape passed through the retrohepatic tunnel.Results In all,32 patients underwent right hepatectomy using this maneuver,in cluding 15 cases via anterior approach and 17 via classic approacK Liver hanging tapes were placed successfully in all 32 cases without related complications,such as short hepatic vein injury and major bleeding.The parenchymal transection time was 25 45 min,the hepatic vascular control time was 20 32 min and the intraoperative blood loss was 300-1 300 ml.No postoperative liver dysfunction or peri operative death occurred.Conclusions Chen＇ s liver hanging maneuver contributes to good view of ana tomic structures,time saving and less bleeding,This method with technically easy has a good prospect for clinical application in hepatic surgery.