前入路并绕肝提拉法右半肝切除术在肝外伤的运用

Application of anterior approach and liver hanging maneuver method to right hemihepatectomy for hepatic injury

目的评价前入路并绕肝提拉法对外伤性右半肝切除术的临床应用价值。方法解剖分离肝脏后,于下腔静脉前间隙建立肝后隧道,置弹力带提拉肝脏,绕肝提拉法配合右肝血流阻断,行右半肝切除术。结果 42例肝破损≥Ⅳ级患者行全入路肝切除手术,其中37例成功置入绕肝提拉带,手术成功,无相关并发症。结论前入路绕肝提拉法行右半肝切除术,仅阻断患侧肝血流,手术从容、安全可靠,适用于严重肝损伤的右半肝切除术,值得临床应用推广。

[Objective] To evaluate the value of clinical application of anterior approach and liver hanging maneuver method in right hemihepatectomy for hepatic injury. [Methods] The space before inferior vena eava （IVC） was separated, the retro-hepatic tunnel was established and the liver was pulled with an elastic belt. Using liver hanging maneuver, together with anterior approach and the right hepatic blood occlusion, right hemihepateetomy was performed. [Results] Anterior approach was selected for liver resection in 42 cases with grade IV hepatic injury, among which liver hanging belts were successfully implanted into 37 cases. The operations were all successful without the occurrence of associated complication. [Conclusions] The anterior approach with liver hanging maneuver method is a safe and reliable method for right hemihepatectomy. This method is recommended for right hemihepatectomy in severe liver jury.