Bimanual 'bi-finger' liver hanging maneuver: an alternative and safe technique for liver hanging.
Bimanual 'bi-finger' liver hanging maneuver: an alternative and safe technique for liver hanging.
复制标题
双手“双指”肝脏悬挂操作：另一种安全的肝脏悬挂技术。
DOI：
10.1080/13651820701216208
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
A. Çoker
中科院分区：
文献类型：
--
作者：
U. Aydin;P. Yazıcı;M. Zeytunlu;M. Kılıç;A. Çoker
背景
目前，一种流行的右肝切除方法是肝切除加肝悬吊法。这项研究的目的是在不使用任何器械的情况下，提供一种替代的、安全的方法，从而避免受伤。
患者和方法
自2005年3月至2006年4月，对22例右半肝切除患者行双指双指肝悬吊术，术后前瞻性收集资料。
结果
21/22例(95%)行BBLHM。有1例患者因手指在肝后间隙解剖时发现副肝静脉而停止操作。这条静脉不允许完成BBLHM。右肝切除指征：原发性肝肿瘤11例(52%)，转移性肝肿瘤8例(38%)，包虫囊肿2例(9%)。术中超声(IOUS)显示肝静脉解剖形态正常。出血1例(4%)，用连续6/0聚丙烯缝线缝合中断出血。
讨论
在肝悬吊动作中，最重要的一步是扩大无血管空间，而不出现任何并发症。在本研究中，盲法解剖中用食指代替钳子。BBLHM不仅降低了肝静脉的损伤率，而且通过损伤前的手动检测，还可以预测任何副静脉的存在。这一手法可以更容易地夹住肝静脉，并可控地切除肝脏。使用BBLHM分离肝后间隙产生了一种更安全的方法，使用两个食指而不是手术器械。
BACKGROUND
Currently, a popular method for right hepatectomy is hepatic resection with the liver hanging maneuver. The aim of this study is to present an alternative and safe approach during this maneuver without using any instrument, thus avoiding injury.
PATIENTS AND METHODS
From March 2005 to April 2006, a bimanual 'bi-finger' liver hanging maneuver (BBLHM) was planned in 22 right hepatectomies and the data were collected prospectively after operation.
RESULTS
BBLHM was performed in 21/22 patients (95%). The maneuver was stopped in one patient, due to manual detection of an accessory hepatic vein during finger dissection in the retrohepatic space. This vein did not allow completion of the BBLHM. The indications for right hepatectomy included 11 primary hepatic tumors (52%), 8 metastatic right hepatic tumors (38%), and 2 hydatid cysts (9%). Intraoperative ultrasound (IOUS) demonstrated the normal anatomical configuration type of the hepatic veins. Bleeding occurred in one patient (4%), which was interrupted with the use of continuous 6/0 polypropylene suture.
DISCUSSION
The most important step during the liver hanging maneuver is to develop the avascular space without any complication. In the present study, the index fingers were used instead of forceps during the blind dissection. BBLHM not only reduced the rate of damage to the hepatic veins but was also predictive for the presence of any accessory vein by its manual detection prior to injury. This maneuver allowed easier clamping of the hepatic veins and controllable hepatic resection. Dissection of retrohepatic space with the BBLHM produces a safer method, using both index fingers instead of a surgical instrument.
影响因子：
9
作者：
Kokudo, N;Imamura, H;Makuuchi, M
通讯作者：
Makuuchi, M