陈氏绕肝双悬吊法联合右半肝血流阻断行右后叶肝肿瘤切除术  

Application of right hepatic pedicle occlusion plus Chen＇ s liver hanging maneuver in right posterior lobe tumor resection

作　　者：王鹏飞[1] 刘志伟[1] 蔡守旺[1] 曾建平[1] 焦华波[2] 王大东[2] 杨世忠[1] 杜俊东[2] 冯健[1] 辛宪磊[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853 [2]解放军总医院第一附属医院肝胆胰脾外科

出　　处：《腹部外科》2015年第2期82-84,共3页Journal of Abdominal Surgery

摘　　要：目的评价右半肝阻断技术结合陈氏绕肝双悬吊法在右后叶肝肿瘤切除术中的应用价值。方法2011年1月至2015年1月，在37例解剖性肝脏右后叶切除术中应用持续右半肝及陈氏绕肝双悬吊法辅助肝切除。右后叶肝肿瘤行右后叶切除时，采取持续右半肝阻断技术并结合陈氏绕肝双悬吊法经下腔静脉右侧放置2根提肝带，离断肝实质的过程中通过牵拉提肝带辅助肝切除。结果全组共37例肝右后叶肿瘤病人行肝右后叶肿瘤切除术。术中均成功分离出右半肝肝蒂和右后叶肝蒂，游离右肝后均成功放置绕肝提拉带，断肝时行右半肝持续肝门阻断，术中无胆管损伤、肝短静脉、肝右静脉撕裂和大出血等相关操作并发症。肝实质离断时间17~28min，阻断时间约20~30min，术中出血量60~330ml。术后第1天丙氨酸转氨酶（ALT）183~352U／L，生化指标均在1周内恢复正常，无围手术期死亡。结论右半肝持续阻断结合陈氏绕肝双悬吊法有助于减少右后叶肝切除术中出血量以及改善手术野，缩短肝实质离断时间，减轻肝脏缺血再灌注损伤，其操作简单、使用安全、适用范围广泛。Objective To evaluate the application value of right hepatic pedicle occlusion plus Chen＇s liver hanging maneuver in improving the operation safety of right posterior hepatectomy. Methods During right posterior hepatectomy, an occlusion of right hepatic pedicle plus Cherfs hanging liver maneuver was used to assist liver resection. Results A total of 37 patients underwent right posterior hepatectomy using this approach. Right hepatic pedicle and right posterior pedicle were dissected successfully and liver hanging tapes placed without such complications as bile duct injury, short hepatic vein injury or major hemorrhage. The parenchymal transection time was 17-28 min, hepatic vascular control time 20-30 rain and intraoperative blood loss volume 60-330 ml. Liver functions returned to normal within 1 week and there was no perioperative mortality. Conclusions Right hepatic pedicle occlusion plus Cherts liver hanging maneuver may minimize bleeding, obtain an excellent of anatomic structures and shorten operative duration during right posterior lobe tumor resection. Such an approach shall have bright prospects for clinical application in hepatic surgery.

关 键 词：右肝蒂阻断 陈氏绕肝双悬吊法 右后叶肝切除 肝肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]