经右肝肾间隙单孔腹腔镜肝Ⅶ段切除术

The single-port laparoscopic hepatectomy of segment Ⅶ through right perirenal space

术中取右侧折刀卧位,于右腋中线,髂嵴上2cm处做一弧形4cm切口,扩充右侧后腹膜间隙,充气后分别置入10cm、12cm Trocar及抓钳,打开外侧肾筋膜,进入右肾周间隙,分离肾前脂肪,显露右侧肾上腺,于其前外侧探查后腹膜,右肾前通过肾筋膜前后两层之间可直接到达肝裸区。探查肝脏,见血管瘤位于肝Ⅶ段,色红,质软,界清。完整切除肝Ⅶ段,断面充分止血。标本套袋后取出。术毕,时长3.4h,术中出血约600ml。术后病检回报为右肝海绵状血管瘤。

Preoperative diagnosis was right hepatic hemangioma. During the operation, a 4 cm incision was made at the middle line of the right axilla and 2 cm above the iliac crest to expand the right posterior peritoneal space. The 10 cm and 12 cm Trocar and grabbing forceps were placed respectively. The lateral renal fascia was opened, the right perirenal space was opened, the anterior renal fat was separated, the right adrenal gland was exposed, and the anterior and lateral peritoneum was explored. The anterior and posterior peritoneum of the right kidney was directly accessible through the anterior and posterior layers of the renal fascia. It reaches the bare area of liver. Exploration of the liver showed that the hemangioma was located in the seventh segment of the liver, red, soft and clear. Segment VII of the liver was completely resected and hemostasis was achieved. Samples were bagged and removed. The operation lasted 3.4 hours and bleeding was about 600 ml. Postoperative pathological findings were right hepatic cavernous hemangioma.