腹腔镜半肝切除术

Laparoscopic hemihepatectomy

肝蒂入路的优势:1)减少全肝阻断时间;2利于控制术中出血;3)减轻剩余肝脏缺血再灌注损伤;4)降低术中肿瘤经门静脉播散的风险。手术要点:1)通过合适的方法处理Glisson肝蒂是手术成功的关键,如鞘内解剖法;2)另一关键技术就是肝实质的分离,肝门板从Laennec膜分离到肝蒂,尽可能保留Laennec膜,同时将肝蒂与肝门板分离,必要时从Glisson分支上解剖肝实质。这种入路操作能分离更深的第三级分支肝蒂,如IVa段肝蒂、VI-VI段肝蒂和VI段肝蒂等,借助吲哚菁绿荧光导航可以更好地识别深部的肝段间平面和切除边界,实现更精准的解剖切除。

The dissection and treatment of liver pedicle is the core of laparoscopic anatomic hepatectomy.1)reducing overall clamping time of whole liver blood flow;2)facilitating intraoperative bleeding control;3)minimizing residual liver ischemia-reperfusion injury;4)decreasing risk of intraoperative tumor dissemination through the portal vein.Key points for operation:1)Successful execution relies on appropriate management techniques for Glisson's pedicle,such as intrathecal dissection;2)Another crucial technique involves separation of hepatic parenchyma where Laennec's membrane is preserved while separating it from hepatic portal plate towards hepatic pedicle,with further dissection if necessary from Glisson's branch to access deeper third-grade branched pedicles like segment IV a,segment VI-VII,and segment VIl etc.By utilizing ICG fluorescence navigation assistance,deep intersegment planes and resection boundaries can be better identified to achieve more precise anatomical resections.