肝圆韧带入路的解剖性肝切除术

Anatomic hepatectomy through hepatic round ligament approach

目的 介绍一种利用肝圆韧带作为入路的肝切除术.方法 2008年2月～2012年5月间,笔者采用肝圆韧带入路的方法行肝切除术56例.该入路利用肝圆韧带作为解剖学标志,在不阻断肝门的情况下,将需要切除的肝叶或肝段的动脉、门静脉、胆管在Glisson鞘内一并结扎,并利用圆韧带裂,镰状韧带或是肝脏缺血线作为切肝的参照线,行解剖性肝切除术.结果 56例中,行左外叶切除术18例（32.1％）,左半肝切除33例（58.9％）,左半肝＋尾叶切除5例（8.9％）.平均手术时间为220 （95～330） min,术中失血量为200（100～ 900） ml,5例（8.9％）需要术中输血.术后4例（7.1％）出现并发症,包括2例肺部感染,1例腹水,1例腹腔感染,无重大并发症发生.术后1个月内无患者死亡.结论 肝圆韧带入路是一种简单、安全、可行的肝切除手术方式.

Objective To describe the hepatectomy through hepatic round ligament approach.Methods From February 2008 to May 2012,57 cases received hepatectomy through hepatic round ligament approach;taking the round ligament of liver as the anatomic mark,the hepatic lobe to be removed,the hepatic segmental artery,portal vein and bile duct were all ligated inside the Glisson＇s sheath; anatomic hepatectomy was performed,taking the fissure of round ligament,the falciform ligament or the demarcation line of hepatic ischemia as the reference line of resection.Results Among the 56 patients,18 patients （32.1％） had left lateral hepatectomy,33patients（58.9％）had left hemihepatectomy,5 patients（8.9％）had left hemihepatectomy combined with resection of caudate lobe.The average time length of the operations was 220 minutes （ranging from 95 to 330 minutes）,while the average blood loss volume in operation was 200 ml（ranging from 100 to 900 ml） ;5 patients（8.9％）had blood transfusion in operation;complications after operation occurred in 4 patients（7.1％）,including lung infection in 2 patients,ascitic fluid in 1 patient and abdominal infection in 1 patient;no life-threatening complications occurred and no death was observed within 30 days after operation.Conclusions Hepatic round ligament approach is an easy,safe and feasible technique for anatomic hepatectomy.