腹腔镜解剖性肝S4切除治疗早期肝细胞癌(Laennec入路联合背侧入路)

Laparoscopic anatomical segmentectomy via laennec approach with dorsal approach for S4 for early hepatocellular carcinoma

肝细胞癌患者(CNLC2019 Ia期)接受腹腔镜解剖性S4切除术治疗。采用腹腔镜五孔法,建立二氧化碳人工气腹,离断肝圆韧带及镰状韧带后,沿圆韧带左侧劈开肝实质找到脐裂静脉终末支,Laennec入路全程显露脐裂静脉直至肝中静脉根部,Laennec入路解剖出肝S4肝蒂10余支并离断,背侧入路结合Laennec入路从头侧全程显露肝中静脉,最后沿肝表面缺血线和肝中静脉完整切除肝S4。延长正中操作孔,取出标本。

The patient with hepatocellular carcinoma(CNLC2019 stage Ia)underwent laparoscopic anatomic segmentectomy for S4.Under laparoscopy,five holes and artificial pneumoperitoneum with CO2 established.After the ligamentum teres and falciform ligament were dissected,the liver parenchyma was splitted along the left side of the ligamentum teres to expose the terminal branches of the umbilical fissure vein.Then the umbilical fissure vein was exposed to the root of the middle hepatic vein with Laennec approach.More than 10 pedicles of S4 were separated and disconnected through Laennec approach.The middle hepatic vein was fully expose from the cephalic side by dorsal approach combined with Laennec approach.Finally,S4 was resected completely along the ischemic line of the liver surface and the middle hepatic vein.The median operating hole was extended to remove the specimen.