摘要
Objective： The liver hanging maneuver （LHM） is rarely applied in laparoscopic right hepatectomy （LRH） because of the difficulty encountered in retrohepatic tunnel （RT） dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the Goldfinger dissector to create a total RT been reported. This study＇s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the Goldfinger dissector in LRH. Methods： Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the Goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results： The median age of patients was 58 （range, 51-65） years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 （40-150） mm. The median operative time was 320 （282-358） min with a median blood loss of 200 （200-600） ml. Laparoscopic LHM was achieved in a median of 31 （21-62） min, and the median postoperative hospital stay was 14 （9-16） d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions： The Goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the Goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.
目的：评估金手指在腹腔镜右半肝切除术中快速简易建立肝后隧道实行绕肝带提拉的可行性和安全性。创新点：在腹腔镜右半肝中很少采用绕肝带提拉,这是因为在腹腔镜下解剖肝后隧道和置放绕肝带难度极大。本文首次详细报道在腹腔镜右半肝切除术中快速简易建立肝后隧道来实行绕肝带提拉,同时首次报道运用金手指在腹腔镜下建立完整的肝后隧道。方法：选取2015年3月至7月间5例连续接受前入路腹腔镜右半肝切除术并行绕肝带提拉的患者为研究对象,运用金手指在腹腔镜下进行5步法建立肝后隧道,收集和研究这些患者的手术资料。结论：这5例患者的中位年龄为58岁（范围51~65岁）。其中,1例患有肝内胆管结石,4例患有肝细胞性肝癌。肿瘤中位直径为90 mm（范围40~150 mm）,手术中位时间为320 min（范围282~358 min）,中位失血量为200 ml（范围200~600 ml）,腹腔镜下绕肝带提拉中位完成时间为31 min（范围21~62 min）,术后中位住院时间为14 d（范围9~16 d）。术中未行输血,未发生中转开腹;术后并未发生严重肝脏并发症,无患者死亡。因此运用金手指进行肝后隧道建立是有效可行的。采取5步法可快速简易建立肝后隧道,有助于在腹腔镜右半肝切除术中安全有效进行绕肝带提拉。
基金
Project supported by the General Research Project of Medicine and Science of Zhejiang Province(Nos.2014KYB119 and 2015KYB221),China
