right hepatic trilobectomy

This procedure removes all liver tissue except the left outer lobe of the liver, that is, the right half of the liver plus the left inner lobe, which accounts for 85% of the entire organ volume. Patients with cirrhosis cannot use superhepatectomy. Treatment of diseases: biliary hemorrhage, liver abscess Indication Liver tumor; liver trauma; liver abscess; intrahepatic bile duct stones; biliary tract hemorrhage; Preoperative preparation Surgical procedure 1. Position: supine position, the right lower back with a yarn bag, padded high, so that the body and the operating table plane angle of 15 ° ~ 30 °. 2. Incision: Generally, the right upper transabdominal rectus muscle or the right upper right side incision is used for exploration. When the right hepatic resection is decided, because the scope of surgery is large, it can be extended to the upper right side, and the chest and abdomen are combined with the incision, and the diaphragm is cut. When the baby or child underwent right hepatectomy, the chest should not be opened. The right upper abdomen incision or the inferior costal incision should be used. If necessary, the right rib arch cartilage can be cut off. 3. Expose the first hepatic hilum: according to the right hemi-hepatic method, the ligation of the cystic duct, the right hepatic duct, the right hepatic artery and the right portal vein, and then continue to dissect and separate and retain the structure of the left side of the hepatic portal. The bile duct, hepatic artery and portal vein branch leading to the left inner lobe are separated and ligated in the left hepatic structure. 4. Expose the second hepatic hilum: the right hepatic vein and the hepatic vein were dissected in the infraorbital inferior vena cava, and the two veins were ligated and cut at 0.5 to 1 cm before the inferior vena cava was introduced into the inferior vena cava. In particular, it should be noted that about 60% of the hepatic veins first flow into the left hepatic vein, and then dry into the inferior vena cava. Therefore, it is necessary to ligature and cut the middle hepatic vein before merging into the left hepatic vein, and to preserve the left hepatic vein intact. Once the left hepatic vein is injured at the same time, it will lead to fatal consequences of budd-chiari syndrome. 5. Excision of the liver: After treating and cutting off several short hepatic veins of the inferior vena cava that are introduced into the liver, the fibrosis of the liver and the inferior cavity is separated, so that the liver and the posterior inferior cavity are completely separated. Finally, the liver capsule was cut about 1 cm to the right of the falciform ligament. The liver parenchyma is bluntly separated by fingers and shank, and should be ligated and cut when encountering the structure of the tube. Finally, the right hepatic and left inner lobe livers were removed. 6. Suture the liver section: suture the small blood vessels or small bile ducts of the liver section to stop bleeding, and then suture the gluten-like ligaments to cover the rough surface.