解剖性肝切除手术切面的确定

Determination of surgical plane in anatomical liver resection

解剖性肝切除是精准肝脏外科的重要组成部分。精确判定拟切除肝段的边界是实施解剖性肝切除的前提和关键。综合应用肝脏解剖学标志和术中超声定位技术、选择性目标肝蒂阻断技术、目标肝段门静脉染色技术及以肝静脉为导向的肝实质离断技术可以帮助在术中精准地确定肝脏切面并引导切面走向。解剖性肝切除的效果应以肝脏切面标志血管的显露和剩余肝组织的缺血或瘀血区域来判定。

Anatomical liver resection plays an important role in the practice of “Precision Liver Surgery”. Its anatomical preciseness is based on the determination of the inter-segmental plane of the liver to be resected. A comprehensive application of the landmark vessels,the intraoperative ultrasound,the selective portal pedicle clamping,the segmental portal staining and the hepatic vein-oriented techniques are helpful to precisely guide the anatomical parenchymal transection. The preciseness of “anatomical” is determined through the exposure of the landmark hepatic veins and the ischemic or congestive area with the remnant liver.