逆行右半肝联合全尾状叶肿瘤切除术

Retrograde caudate lobectomy combined with right hemihepatectomy

  • 摘要: 随着肝脏外科手术技术的不断成熟,肝尾状叶不再是肝脏手术的禁区,但该部位的手术仍具有挑战性。2007年11月,第二军医大学东方肝胆外科医院运用逆行肝切除法成功为1例44岁男性肝尾状叶巨大肿瘤患者实施逆行右半肝联合全尾状叶肿瘤切除术。术中阻断门静脉和肝动脉1次,阻断时间为19 min,术中出血量为4500 ml。该术式难度较大,但较好地解决了尾状叶肿瘤与下腔静脉粘连问题,降低了术中不可控制的大出血风险及患者术中死亡率。

     

    Abstract: Retrograde caudate lobectomy is a proper technique to resect the tumor in caudate lobe when the tumor is  too big or closely adherent to the inferior vena cava. A male patient aged 44 years was admitted to the Eastern Hepatobiliary Surgery Hospital in November 2007. The ligaments around the liver were firstly dissected to mobilize the whole liver, and the right hepatic pedicle was dissected and ligated, then the liver was splited  anteriorly  along the Cantlie′s line. The tumor was opposed in the sight and then it was dissected from the liver parenchyma. The short hepatic veins were ligated and the tumor was detached from the inferior vena cava. The inflow blood was occluded for 19  minutes, and the total blood loss was 4500 ml. The technique of retrograde caudate lobectomy can improve the success rate and safety of caudate lobectomy when the tumor in the  caudate lobe is too large or adherent to the inferior vena cava.

     

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