摘要
腹腔镜下以肝静脉为导向确定精确的断肝平面进行肝实质的离断是解剖性肝切除的关键。肝中静脉(MHV)具有重要的功能和相对固定的解剖学位置,寻找并显露MHV走行并判断和修正断肝平面对腹腔镜解剖性肝切除至关重要。腹腔镜下MHV寻找显露的难点在于对于MHV应用解剖的理解和肝实质离断技巧、术中出血控制和处理;同时由于手术视野、操作空间等影响,适合的手术入路对于MHV寻找显露尤为重要。因此,须熟悉MHV解剖,同时采用适当的技术在肝实质离断过程中寻找和显露MHV,对于确定切肝平面、减少术中出血、安全离断肝实质均有帮助,最终达到解剖性、功能性、精准性肝切除的目的。
The key to anatomic hepatectomy lies in determining precise liver transection planes guided by hepatic veins during laparoscopic parenchymal division.The middle hepatic vein(MHV),with its crucial functional role and relatively fixed anatomical position,plays a pivotal role in laparoscopic anatomic hepatectomy and its identification,exposure,and the continuous evaluation/adjustment of transection planes are essential.The challenges in laparoscopic MHV exposure primarily involve understanding MHV anatomical variations,mastering parenchymal dissection techniques,and effectively controlling intraoperative hemorrhage.Meanwhile,factors like limited surgical field and restricted operating space make appropriate surgical approaches particularly critical for MHV identification.Therefore,comprehensive knowledge of MHV anatomy combined with proper techniques for MHV exposure during parenchymal transection contributes to accurate determination of resection planes,reduced intraoperative bleeding,and safe parenchymal division.This integrated approach ultimately achieves the goals of anatomic,functional,and precisionoriented hepatic resection.
作者
尤楠
郑璐
YOU Nan;ZHENG Lu(Department of Hepatobiliary Surgery,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)
出处
《中国实用外科杂志》
北大核心
2025年第4期473-480,共8页
Chinese Journal of Practical Surgery
基金
重庆市科卫联合医学科研项目面上项目(No.2023MSXM004)。
关键词
腹腔镜
解剖性肝切除
肝中静脉
显露
laparoscopy
anatomical hepatectomy
middle hepatic vein
expose
