Hepatectomy

Liver resection is a surgical treatment that removes the diseased part of the liver and preserves the liver in a healthy area. Treating diseases: liver cancer Indication 1. The whole body is in good condition, and the heart, lung and kidney function are not seriously damaged, and it can tolerate surgery. 2. No distant transfer. 3. Liver function Child grade B or above. 4. Imaging examination showed that the tumor was confined to 1/2 or half of the liver, and did not invade the hilar and inferior vena cava. 5. Preoperative judgment of the remaining liver after surgery is of sufficient quality and blood supply and venous return are not affected, liver function can be compensated. 6. Resectable recurrent liver cancer. 7. After treatment of liver cancer, the second-stage resection is feasible. Contraindications 1. The general condition is poor, and heart, lung and kidney diseases cannot tolerate surgery. 2. Liver function ChildC level. 3. Multiple metastases outside the liver. 4. Multiple lesions in the liver (more than 3) scattered in the liver; tumors invading the hilar or inferior vena cava are not expected to be removed. Preoperative preparation Strengthen nutrition, correct anemia and hypoproteinemia, correct bleeding tendency and water, electrolyte imbalance, gastrointestinal preparation and blood preparation. Surgical procedure 1. Anesthesia: continuous epidural anesthesia or (and) inhaled general anesthesia. 2. Position and incision: In the supine position, the operating bed is shaken as needed during the operation to tilt the patient to the left or right. Incision under the right costal margin, or as needed, the "human" incision under the double costal margin, combined with the chest and abdomen. 3. Exposure: free tumor and adhesion of the liver to the surrounding tissue, as needed, disconnect the round ligament of the liver, the falciform ligament, the left and right triangular ligaments, or the left and right coronary ligaments, so that the liver is fully free, the palm of the operator can be from behind Hold the liver. 4. Control liver hemorrhage: intermittent hepatic occlusion at room temperature is the most commonly used method, in addition to local hepatic vascular occlusion method (finger hemorrhage controlled by finger press, selective intrahepatic portal vein branching, hepatic sulcus Legitimate), selective hepatic vascular exclusion and bloodless hepatectomy, etc., are selected as needed. 5. Resection: regular liver resection and irregular liver resection. Regular hepatectomy includes segmentectomy, hepatectomy, hepatectomy, and hepatic trifoliate resection; irregular hepatectomy is local hepatectomy. The specific method of resection should be determined according to the size of the tumor, the location, the degree of cirrhosis and the general condition of the patient. The method of clamping the liver with clamp method, finger-pinch method, ultrasonic knife (CUSA) and water knife should be selected according to the conditions and the experience of the surgeon. During the process of liver rupture, the bile duct, hepatic artery and portal vein must be ligated one by one, and the hepatic vein above 1 mm diameter must also be ligated. 6. Treatment of liver section: Larger bleeding points or bile leakage should be done with 8 suture ligation with fine thread; high temperature gas beam generated by argon knife can condense small bleeding point or extensive oozing, which is fast and effective. The purpose of hemostasis; fibrin adhesive, bio-adhesive direct coating or spray cross-section, can play a good role in coagulation and promote wound healing; pedicled omentum or adjacent ligament covering the section, is beneficial for hemostasis and wound healing. It should be emphasized that the section that can be sutured together should be sutured with silk thread as much as possible after the section has stopped bleeding.