Ultrasonically assisted retrohepatic dissection for a liver hanging maneuver
Ultrasonically assisted retrohepatic dissection for a liver hanging maneuver
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DOI：
10.1097/01.sla.0000186129.46123.81
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发表时间：
2005-11-01
影响因子：
9
通讯作者：
Makuuchi, M
中科院分区：
文献类型：
--
作者：
Kokudo, N;Imamura, H;Makuuchi, M
目的：在术中超声 (IOUS) 的辅助下，建立一种更安全、技术上更容易的肝悬挂手术肝后解剖。 背景资料摘要：Belghiti 等人描述的肝脏悬挂手术是一种创新的肝脏悬挂技术，可用于困难的主要右肝切除术或活体肝移植的供体手术。该手术最重要的并发症是肝短静脉损伤和随后的大出血，发生率为4%至6%。 方法：在中肝静脉和左肝静脉之间的肝上下腔静脉（IVC）进行颅骨解剖后，从尾状叶后面的尾部边缘插入长的轻型弯曲凯利钳，并沿着IVC的前中线向颅内穿过。在解剖中间，可以看到引流尾状叶的肝固有静脉 (PrCV)。 IOUS 确认了安全的解剖路径，确定了钳尖、PrCV 的位置和颅后肝解剖的尾端。当IOUS显示钳尖已到达颅底解剖尾端时，操作者可用手指感觉到钳尖，肝后解剖完成。 结果：2003年9月至2004年7月，共完成50例成人活体肝移植供体手术。 40 例（80%）肝后解剖是可行的。其中，对 34 名捐献者进行了超声辅助的肝后解剖。 IOUS 对 48 名捐赠者 (96%) 的 PrCV 进行了可视化。这些 PrCV 的位置与 IVQ 右边缘的差异很大（60 度 - 175 度），并且没有明显的标志来识别 PrCV 的位置和安全解剖路线（55 度 - 130 度）。 IOUS发现3例解剖夹指向PrCV，并改变解剖方向以避免受伤。所有病例均未出现大量出血或肝后解剖相关并发症。结论：在IOUS的辅助下，下腔静脉前表面与肝脏之间盲性解剖的整个过程可以清晰可见。 IOUS 还可以识别 PrCV，即肝后解剖中最危险的点。
Objective: To establish a safer and technically easier retrohepatic dissection for the liver hanging maneuver with the assistance of intraoperative ultrasound (IOUS).Summary Background Data: The liver hanging maneuver described by Belghiti et al is an innovative suspending technique of the liver and is useful in difficult major right hepatectomies or in donor operations for living donor liver transplantation. The most important complication of this procedure is injury to the short hepatic veins and subsequent massive bleeding with an incidence of 4% to 6%.Methods: After the cranial dissection of the suprahepatic inferior vena cava (IVC) between the middle and left hepatic veins, a long light curved Kelly clamp is inserted from the caudal edge behind the caudate lobe and passed cranially along the anterior midline of the IVC. On the midway of the dissection, the proper hepatic vein draining the caudate lobe (PrCV) is visualized. A safe dissection path is confirmed by IOUS, identifying the position of the clamp tip, PrCV, and the caudal end of the cranial retrohepatic dissection. When IOUS shows that the clamp tip has reached the caudal end of the cranial dissection, the operator can feel the clamp tip with his/her finger and the retrohepatic dissection is completed.Results: From September 2003 to July 2004, 50 donor operations were performed for adult living donor liver transplantation. Retro-hepatic dissection was feasible in 40 cases (80%). Of these, a US-assisted retrohepatic dissection was performed in 34 donors. PrCVs were visualized by IOUS in 48 donors (96%). The location of these PrCVs varied significantly (60 degrees-175 degrees) from the right edge of IVQ, and there were no distinct landmarks for identifying the location of PrCVs and safe dissecting course (55 degrees-130 degrees). IOUS found that the dissecting clamp was heading to the PrCV in 3 cases and the direction of dissection was shifted to avoid injury. No substantial bleeding or no other complication related to retrohepatic dissection was encountered in any of the cases.Conclusions: With the aid of IOUS, the whole course of the blind dissection between the anterior surface of the IVC and the liver could be clearly visualized. IOUS could also identify the PrCV, the most dangerous point in the retrohepatic dissection.