左半肝切除术

Left hemihepatectomy

以右肋弓下斜切口20 cm入腹,探查:无腹水,无腹膜转移,肿瘤位于左右胆管交汇区,累及肝中静脉。1、解剖肝总动脉、清扫第8组淋巴结。骨骼化肝固有动脉、肝动脉、GDA、清扫12组淋巴结,因肝右动脉优势支发自SMA,故切断肝固有动脉、骨骼化门静脉主干,断扎门静脉左支。于胰腺上缘断CBD,远端切缘病理回报阴性。清扫13组淋巴结。2、解剖并离断门短静脉。游离左外叶后将其向右翻起,解剖并离断肝短血管,直至肝左、肝中汇合处。3、循肝脏缺血线做预切线,由下至上、由前至后劈肝,保持CVP≤5 cmH_2O。Tri-Staple棕钉闭合肝左静脉,完整切除左半肝及尾状叶。切除被肿瘤侵及肝中静脉长约2 cm,血管夹阻断肝中静脉远近端,6-0 prolene线端端吻合肝中静脉。肝脏断面见Ⅴ、Ⅵ、Ⅶ及Ⅷ段四支胆管断端,切缘送病理,未见癌。四支胆管成型后胆管空肠Roux-en-Y吻合。

Open surgery was performed by using a 20 cm abdominal incision under the arch of right rib.Exploration:No ascites,no peritoneal metastasis,the tumors located in the junction of left and right bile ducts,involving the middle hepatic vein.1.To dissect common hepatic artery and to sweep group 8 lymph nodes.To skeletonize proper hepatic artery,hepatic artery,GDA,and to group 12 lymph nodes.Because the dominant branch of right hepatic artery originated from SMA,proper hepatic artery and left branch of portal vein were dissected,ligated and cutted off respectively,by skeletonizing the portal vein.CBD was cutted above the pancreas and group 13 lymph nodes were dissected,with a negative distal margin.2.The short portal vein of caudate lobe was dissected.After dissociating the left lateral lobe,turn it to the right,to dissect and to cut off the short hepatic vessels until the confluence of the left and middle liver.3.To dissect liver from bottom to top,from front to back,ensuring CVP≤5 cmH2O.Three staples were used to cut off the left hepatic vein,and the left half of the liver and caudate lobe were completely removed.The length of the tumor invading the middle hepatic vein was about 2cm.The distal and proximal part of the middle hepatic vein was blocked by using clamp,and the middle hepatic vein was anastomosed by using 6-0 Prolene suture.In the section of liver,the broken ends of four bile ducts inⅤ,Ⅵ,ⅦandⅧsegments were seen,with a clear negative margin.Roux-en-Y anastomosis of bile duct jejunum was performed after the formation of four bile ducts.