CAJ | 학술논문

前入路肝切除术是指先离断肝实质后游离肝脏的肝切除方法;绕肝悬吊是指在肝后下腔静脉前方放置悬吊带,供在切肝过程中提起肝脏.2011年10月中山大学孙逸仙纪念医院采用前入路、绕肝悬吊、解剖性肝右三叶切除术治疗1例54岁男性肝癌患者.肿瘤位于肝左内叶和右半肝,长径约16 cn.术前肿瘤分期为ⅢA期,T3N0M0;术前评估ICG R15为5.4％,肝左外叶肝脏体积占标准肝脏体积的44％;左肝管受压、轻度扩张.术中首先分离、切断入肝血流,包括肝右动脉、门静脉右支、肝中动脉、门静脉左内叶分支;然后在镰状韧带的右侧离断肝实质,期间在肝后下腔静脉前打隧道并悬吊肝脏;切断右肝管;接着分离、切断肝中静脉和肝右静脉;游离肝周韧带,移出肝右二叶;最后行左肝管、肝总管端端吻合.手术时间为4h,术中出血量为350 mL.患者术后康复顺利,术后4个月复查MRCP示胆管吻合口通畅,肝内未见肿瘤复发.
전입로간절제술시지선리단간실질후유리간장적간절제방법;요간현조시지재간후하강정맥전방방치현조대,공재절간과정중제기간장.2011년10월중산대학손일선기념의원채용전입로、요간현조、해부성간우삼협절제술치료1례54세남성간암환자.종류위우간좌내협화우반간,장경약16 cn.술전종류분기위ⅢA기,T3N0M0;술전평고ICG R15위5.4％,간좌외협간장체적점표준간장체적적44％;좌간관수압、경도확장.술중수선분리、절단입간혈류,포괄간우동맥、문정맥우지、간중동맥、문정맥좌내협분지;연후재렴상인대적우측리단간실질,기간재간후하강정맥전타수도병현조간장;절단우간관;접착분리、절단간중정맥화간우정맥;유리간주인대,이출간우이협;최후행좌간관、간총관단단문합.수술시간위4h,술중출혈량위350 mL.환자술후강복순리,술후4개월복사MRCP시담관문합구통창,간내미견종류복발.
Anterior approach refers to a method of hepatectomy which is first to resect the hepatic parenchyma and then to free the liver; hanging maneuver refers to placing a tape before the inferior vena cava for hanging the liver during hepatectomy.In October 2011,anatomical trisectionectomy was performed on a 54-year-old male patient with large hepatocellular carcinoma in the left medical lobe and right lobe with anterior approach and hanging maneuver.The diameter of the tumor was 16 cm,and was in the ⅢA/T3NOM0 stage.The indocyanine green retention at fifteen minutes was 5.4％,and the ratio of hepatic left lateral lobe volume over the standard total liver volume was 44％.The left bile duct was slightly dilated because of the compress of the tumor.The operation started with the isolation and dissection of the inflow vessels,including the right hepatic artery,the right portal vein,the middle hepatic artery,the portal vein branches of left internal lobe.The hepatic parenchyma transection was performed along the fight side of the falciform ligament.A tape was passed between the anterior surface of inferior vena cava and liver,and the liver was suspended during the transection.The left bile duct was cut at the right side of round ligament,and then the middle hepatic vein and the right hepatic vein were resected.The ligaments around the liver were dissected and the right hepatic lobe was removed.Finally,the end-toend anastomosis between the left hepatic duct and the common hepatic duct was performed.The operation lasted for 4 hours and the intra-operative blood loss was 350 mL.The patient was recovered well.At the end of 4 months after surgery,magnetic resonance cholangiopancreatography showed that the anastomosis of the bile duct was unobstructed,and there was no recurrence of tumor inside the liver.