partial hepatectomy

Partial hepatectomy is a surgical procedure that preserves the healthy area as much as possible by removing the diseased part of the liver. Treatment of diseases: liver cancer metastatic liver cancer primary liver cancer Indication Partial hepatectomy is mainly for patients with hepatic malignancies or giant benign tumors. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Anesthesia: general anesthesia or epidural anesthesia. 2. Position: supine position. 3. Incision: The right oblique incision is used in the lower costal margin. The human shaped incision is used in the middle, and the L shaped incision can also be used. 4. First hepatic anatomy: In order to prevent massive hemorrhage during anatomy of the hilar and liver, according to the requirements of the Pringle method (full liver occlusion), the gauze strip or catheter can be used to suspend the liver through the small omentum hole. The duodenal ligament is used to control blood flow. Use a large hook or hanging hook to pull the liver upward, reveal the first hepatic hilum, open the duodenal ligament at the level of the cystic duct, and expose and suspend the main hepatic duct, the hepatic artery and the portal vein, continue to separate upwards. 1~2cm to the bifurcation, according to the left (right) hepatic resection, ligation or vascular clamp to block the left (right) hepatic duct, left (right) artery and left (right) portal vein Each branch. 5. Second hepatic anatomy: first cut off the ligament around the liver, pull the liver downward, cut the liver sacral ligament to the second hepatic hilum, carefully peel the surface membrane structure of the hepatic vein, distinguish the right, middle, Left venous branch, if necessary, cut the liver capsule, distinguish the left hepatic and hepatic veins, bluntly separate and retain the hepatic vein. 6. Liver: According to the left or right hepatic resection, separate the left or right triangular ligament and coronary ligament with an electric knife. 7. Third hepatic anatomy and hepatic short vein treatment: fully dissociate the left (right) liver. If radical left (right) hemi-hepatic or enlarged hepatic resection is performed, the liver and inferior vena cava of the third hepatic portal should be performed. Separation of the perforator, the lateral side of the liver is lifted to the left (right) side. Under normal circumstances, there is a potential loose connective tissue between the liver and the inferior vena cava. It is easy to separate the small veins of the liver and the small veins are ligated with thin wires. If the perforating vein is >0.2cm, it should be sutured. 8. Cut the left (right) half of the liver: cut the hepatic capsule 0.5 cm from the left (right) side of the hepatic vein, and use the sonic separator (CUSA) or clamp the liver tissue to reveal the intrahepatic duct system, from the liver The liver is separated from the liver, and the hepatic vessels and hepatic duct are exposed and ligated with a thin wire or a titanium clip. If the liver segment or the leaf vessel and the hepatic duct are to be sutured, the left (right) branch portal vein and the left (right) hepatic vein of the liver should be confirmed. After the cut, the 4-0 non-invasive line was used to make the continuous closure suture. 9. Liver section treatment: firstly carefully suture or electrocautery to stop bleeding, confirm that there is no oozing or leaking bile, you can also spray fibrin glue or cover hemostatic gauze on the liver section, and reset the suture of the hepatic sacral ligament, respectively on the left ( Right) The hepatic fossa and the retina are placed in a rubber tube for drainage, and the abdominal wall is finally sutured layer by layer.