Isolated hepatic caudate lobectomy.
Isolated hepatic caudate lobectomy.
复制标题
孤立性肝尾状叶切除术。
作者：
K. Yanaga;T. Matsumata;H. Hayashi;M. Shimada;K. Urata;K. Sugimachi
背景
孤立尾状叶切除术是一种具有挑战性的外科手术，安全可靠的技术尚未开发。
方法
通过尾状叶的初始流入控制进行孤立尾状叶切除术，通过分割所有短肝静脉从下腔静脉完全动员肝脏，并通过顺时针旋转肝脏在主要肝静脉背侧进行实质分割，同时通过Pringle手法选择性地离断肝脏血管，并闭塞与下腔静脉齐平的主要肝静脉汇合处。
结果
2例肝硬化患者成功接受了该手术，无术中血流动力学不稳定或术后肝功能障碍。
结论
这种技术允许安全和真正的选择性切除尾状叶，而不需要闭塞下腔静脉或静脉转流。
BACKGROUND
Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed.
METHODS
Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularized by Pringle's maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava.
RESULTS
Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction.
CONCLUSIONS
This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.