腹腔镜扩大左半肝联合全尾叶切除术

Extended laparoscopic left hemihepatectomy combined with caudate lobe resection

1.肝门处预置肝门阻断带,必要时行肝门阻断控制出血;2.肝脏肿瘤压迫第一、二、三肝门及下腔静脉,紧贴肿瘤包膜处理各管道,采取左右结合、由浅入深的策略;3.优先离断肝实质,劈肝后分离出左侧肝蒂,以直线切割闭合器离断左侧肝蒂;4.肝实质内紧贴包块包膜离断肝实质;5.肝脏包块侵犯肝中静脉及右侧尾状叶,术中联合肝中静脉及全尾叶切除;6.术中避免损伤右侧肝蒂及右肝静脉;7.术中使用超声刀、Ligasure等能量器械断肝、止血;8.缝合技术在腹腔镜肝切除手术中具有重要作用。

1.Pringle’s maneuver was applied tocontrolintraoperative bleedingduring the surgicalprocedures;2. Sincetumor oppressed the first, second and third hepatic hilum andinferior vena cava, dissectionof the vessels around the tumor wereperformed from right to left side, from shallowerto deeper;3. Priority of liver parenchyma transectionwas followed.whileleft hepatic pediclewas separated and cutoffby usinglinearstaplers;4. The liver parenchyma could be transected along the capsule of the tumor;5. Sincemiddle hepatic veinand right caudate lobewereinvadedby tumor, thus radicalresectionwereperformed;6. Right hepatic pedicle and right hepatic vein were preservedduring operation;7. Ultrasonic scalpel, Ligasure and other energy tools were used to transect the liver parenchyma and to control intraoperative bleeding;8.Stitching techniques played an important role in laparoscopic hepatectomy.