left liver lobectomy

Left hepatectomy is used for the surgical treatment of hepatolithiasis. Hepatic bile duct stones were treated with partial hepatectomy. In 1958, Professor Huang Zhiqiang first created it. More than 40 years of practice has proved that partial hepatectomy for hepatolithiasis, combined with the double effect of relieving hepatic duct obstruction (calculus, especially the presence of hepatic bile duct stricture) and removing purulent infection, effectively improved the liver and gallbladder in China. Long-term treatment effect of tube stones. This experience has been unanimously affirmed. The theoretical basis for the treatment of intrahepatic bile duct stones with hepatectomy is the deep understanding of hepatobiliary stones and/or stenosis, long-term observation and research. Due to the presence of obstruction factors such as stones and/or stenosis, recurrent purulent infection of the intrahepatic bile duct not only aggravates the occlusion of stones and stenosis, but also aggravates the damage of liver parenchyma, leading to liver fibrosis and atrophy; Prone to bacteremia, septic shock, biliary hepatic abscess, bile duct ulcer caused by biliary bleeding, late stage lesions can occur a series of serious consequences such as biliary cirrhosis, portal hypertension. Partial hepatectomy removes the part of the liver tissue that has been severely damaged by obstruction and infection. The benefits are far superior to intrahepatic bile duct stones removal and are an important part of the surgical treatment of hepatolithiasis. In the first military and biliary surgery of the Third Military Medical University, 66 patients who underwent surgery and long-term (mean 8 years) follow-up were treated with partial hepatectomy, and 58 patients with excellent efficacy were 96.6%. In another group of the hospital from July 1975 to July 1989, 270 patients were followed up for 1 to 13 years, and the long-term efficacy was 84.6%. The surgical mortality rate was 1.8%, indicating the important position and role of partial hepatectomy in the surgical treatment of hepatolithiasis and stenosis. Left hepatic lobe resection is performed to remove the left inner lobe and left outer lobe. This kind of operation is mainly used for fibrosis and atrophy of the left hepatic liver caused by long-term hepatic duct obstruction such as left hepatic duct stenosis or stone incarceration. When the left hepatic duct has stones and stenosis but has not caused changes in the liver parenchyma, left hepatectomy is generally not used. Because, in this case, the left outer lobe of the liver is removed, and the liver in the left hepatic duct and the left inferior lobe branch can be removed by probing the hepatic duct of the liver section. This is the main reason why left hepatectomy is less than left lateral resection. Treating diseases: liver cancer Indication The current indications for the use of partial hepatectomy for hepatolithiasis are more active, flexible and extensive than they were more than 30 years ago. This is due to the deepening of the understanding of the disease and the evaluation of the efficacy of various surgical methods. As a result of the development of surgical techniques, the main surgical indications are: 1. Hepatolithiasis limited to one side or one leaf, it is difficult to obtain a clearer by general techniques. 2. One or one of the hepatolithiasis and/or stenosis, accompanied by fibrosis of the liver tissue, atrophy. 3. One or one lobar hepatolithiasis and/or stenosis, accompanied by multiple hepatic abscess or hepatic duct empyema, bile (internal and external) fistula formation. 4. Pan-hepatic bile duct stones, with more concentrated one side or more serious liver damage, one side of the liver can be partially removed, and the other side is treated with stone removal. 5. Intrahepatic bile duct dilatation with stones on one side or one leaf. 6. Hepatic bile duct stenosis and/or calculi confined to a liver segment. 7. One or one of the hepatic bile duct stenosis, stones or cystic dilatation with cancer. 8. Hepatic bile duct stones and (or) stenosis In order to reveal and dissect the hilar structure, it is necessary to remove the hyperplasia and enlargement of the left hepatic lobe. Contraindications 1. Hepatolithiasis, in the state of severe acute cholangitis, especially with bacteremia, septic shock, decompression, drainage surgery should be performed first, and partial hepatectomy should not be performed rashly. 2. In advanced cases, patients with biliary cirrhosis and portal hypertension should not undergo partial hepatectomy before decompression, drainage, and portal pressure reduction. 3. Patients with long-term obstructive jaundice, chronic dehydration, electrolyte imbalance, and hepatolithiasis with obvious coagulopathy, before the effective correction and drainage, the first partial liver resection is very dangerous. 4. Because of the long-term obstruction of one side of the bile duct, liver fibrosis, atrophy, the patient who has reached the "self-removal" state of one leaf or one side (semi-hepatic) liver tissue, if it does not combine stones or infection, no need Partial liver resection. Preoperative preparation Hepatolithiasis, hepatobiliary stenosis, especially those with recurrent seizures of severe cholangitis, long-term obstructive jaundice and biliary fistula, local and general conditions are often poor, and should be carried out at the same time as various examinations and diagnoses Thoughtful preoperative preparation. 1. Supplement blood volume, maintain water and salt metabolism and acid-base balance, especially pay attention to the correction of chronic water loss and hypokalemia. 2. Strengthen and improve the systemic nutritional status of patients. Give a high-protein, low-fat diet and add enough calories and vitamins. Patients with obstructive jaundice should be injected with vitamin K11. Some patients also need fluid replacement and blood transfusion. In patients with complete biliary fistula and hepatic insufficiency, intravenous nutritional support is often required. 3. Check the coagulation mechanism and correct any abnormalities that may occur. Comprehensive analysis was performed together with the results of liver function tests to evaluate liver reserve and metabolic function. 4. Pay attention to protect liver function. Repeated episodes of biliary tract infection and prolonged obstructive jaundice often cause varying degrees of liver damage. If you have biliary cirrhosis, you should pay attention to active liver protection. Patients with long-term external drainage tube, if the daily bile flow is many and the color is light, it is often a sign of liver dysfunction. The inversion of the ratio of white and globulin indicates that the compensatory function of the whole liver is in an unfavorable condition. If you have splenomegaly and ascites, you should first do liver protection treatment. After you have improved, consider the staged treatment. 5. Investigation of bile bacteriology and antibiotic susceptibility testing to use antibiotics more rationally. In some complicated cases, it is often necessary to start systemic application of antibiotics 2 to 3 days before surgery to help prevent surgery or angiography and stimulate cholangitis. If the operation is performed during the onset of cholangitis, penicillin or metronidazole (metidazole) should be administered to control the mixed infection of anaerobic bacteria. 6. Protect and support the body's emergency response capabilities to help smooth out the post-operative traumatic response. These patients have been repeatedly attacked by biliary tract infections and multiple operations, often with physical depletion; and most of them have a history of treatment with different degrees of glucocorticoids, systemic response is low, should pay attention to support and protection. In the operation, hydrocortisone 100 ~ 200mg was intravenously instilled, and 50-100 mg per day can be instilled within 2 days after surgery, which often receives good results. 7. For patients with external drainage, the preparation of the skin of the mouth should be carried out as soon as possible. For excessively long granulation tissue, it should be cut off. For local inflammation and skin erosion, the dressing should be changed frequently and wet if necessary. For mouthwashes with digestive juices, apply zinc oxide paste coating protection. Keep your mouth clean and perform surgery when your skin is healthy. Deworming should be routinely performed after admission. Stomach tubes and catheters should be placed before surgery. 8. Analyze past imaging data to determine the surgical approach. 9. Handle the abdominal wall sinus. 10. Do an iodine allergy test before surgery. Surgical procedure 1. Cut the round ligament, the falciform ligament, the left coronary ligament and the left triangular ligament, and part of the right coronary ligament and the liver and stomach ligament, so that the left lobe liver is fully free. 2. Dissect the hepatoduo duodenal ligament, and separate the left hepatic artery from the hepatic artery by the inner side of the common bile duct, clamp it, cut it, and double ligature. 3. On the left side of the liver transverse fissure, carefully separate the left hepatic duct, the left portal vein, and ligature separately. Due to the recurrent episodes of bile duct cholangitis, there is a dense, thick fibrous scar tissue around the bile duct, which makes it difficult to separate the left hepatic duct and the left portal vein in the sheath. At this time, the portal vein can be separated and exposed to prepare for liver disease. Short-term blocking, reducing bleeding. 4. Broken liver on the left side of the gallbladder fossa and the left edge of the superior and inferior vena cava. In the case of hepatolithiasis, due to fibrosis and atrophy of the left hepatic liver, the boundary between the liver and the right liver is very clear. After the hepatic capsule was incised, the liver tissue was bluntly separated and the small blood vessels and bile duct branches were cut. The left and left hepatic ducts of the portal vein were exposed, separated and clamped in the cut liver section. 5. The left hepatic vein was exposed and isolated on the liver section of the proximal hepatic hilum, and the clamp was cut, and then the liver tissue was separated and the left end of the liver was sutured. T-tube drainage and hepatic section drainage for bile duct placement.