hepatic lobectomy

Mid-hepatic resection refers to the resection of the central region of the liver, including the right anterior and left inferior lobe, retaining the right posterior and left lateral lobe, the amount of resection is equivalent to half of the liver. Because of the pipelines involved in the upper and lower livers, the technology is more complicated. Treatment of diseases: liver cancer hemangiomas Indication Tumors located in the central part of the liver, including liver cancer, gallbladder cancer, hepatic hilar duct hepatic carcinoma and hepatic hemangioma, as well as comminuted injury in the middle of the liver can not be sutured. 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. Anatomy of the first hepatic hilum: After laparotomy, the ligament of the liver and the falciform ligament are cut off, then the right hepatic ligament is cut off, the right lobe of the liver is separated, and the posterior inferior vena cava is revealed. Then, the cystic duct and the cystic artery are cut off at the first hepatic hilum, and the gallbladder is removed. The hepatic duodenal ligament was dissected, and the common bile duct and left and right hepatic ducts, the hepatic artery and the left and right hepatic artery, the main portal vein and the left and right portal vein branches were isolated. The glisson sheath was cut along the right incision, and the portal vein, hepatic artery and bile duct branch of the right anterior lobe were exposed on the outside of the right notch, and these tubular structures were ligated and cut. Further to the left along the hepatic portal, the glisson sheath is cut in the left longitudinal groove, the hepatic artery branch of the left inner lobe can be isolated, and the left inferior branch of the portal vein is exposed on the medial edge of the sagittal left branch of the left main branch of the portal vein. And left inner lobe hepatic duct branch. The left inner lobe hepatic artery, portal vein and bile duct branch were ligated and cut one by one. 4. Dissection of the second hepatic hilum: At the top of the liver, the liver fissure is cut along the middle hepatic vein corresponding to the middle hepatic vein. The depth is about 2 to 3 cm, and the hepatic vein is separated. About 1 cm below the entrance to the inferior vena cava. The liver vein is ligated and cut. 5. Excision of the middle lobe of the liver: After the upper and lower hepatic valves are blocked by the blood vessels in the middle lobe of the liver, the color of the middle lobe region becomes dark purple and the boundary is obvious. A blocking zone can be placed in the first hepatic hilum before the middle hepatic lobe is removed, in order to block the first hepatic portal blood flow if necessary. The liver capsule was cut at 0.5 to 1 cm inside the right interlobular fissure and the left interlobular fissure, and the liver parenchyma was incised in the direction of the inferior vena cava by blunt and sharp separation. The small blood vessels and bile duct branches on the liver section are clamped, cut, and ligated or sewed one by one. The anterior wall of the inferior vena cava should be carefully separated when approaching the dorsal side of the liver. The short venous branch of the liver should be firmly ligated and cut. 6. Repair of the liver section: After the middle lobe of the liver is removed, a wedge-shaped residual cavity with a wide upper and a narrower shape is formed. After careful hemostasis on both sides of the liver, if the tension is not large, suture and close together. If the tension is large, it is not suitable for suturing. It can be covered with a large omentum. Thoracic closed drainage, drainage in the section of the liver, under the armpit and near the retina, and surgery was performed on the chest and abdomen.