Extended left hepatectomy

Expanding left hepatectomy is a surgical procedure to replace left hepatectomy in recent years, which is conducive to the preservation of well-functioning hepatocytes. Treatment of diseases: liver rupture of extrahepatic bile duct injury Indication 1. Liver tumors: benign tumors (siver cavernous hemangioma, hepatic adenoma, hepatic cyst) and malignant tumors (liver cancer, hepatic sarcoma). Liver cancer is divided into primary and secondary. Primary liver cancer only in the early stage of non-diffuse type, no long-distance metastasis, no cachexia, no obvious jaundice, ascites, edema, portal hypertension can be removed, secondary liver cancer can only be cured and metastases in the primary tumor It can only be removed when the single shot is limited. 2. Liver trauma: Larger blood vessels in the liver rupture, causing part of the liver to lose blood supply, large pieces of tissue are broken and broken; liver tissue is severely contused and lacerated, and simple suture repair can not control bleeding or has been seriously infected. 3. Liver abscess: Chronic hard-walled liver abscess with persistent bleeding and long-term coexistence treatment, liver resection is feasible when conditions permit. 4. Intrahepatic bile duct stones: limited to one leaf of intrahepatic stones, severe lesions, causing liver atrophy. 5. Biliary hemorrhage: Hepatic resection and hemorrhage can be removed due to malignant tumor erosion, intrahepatic vascular rupture or intrahepatic localized infection. 6. Hepatic cysticercosis. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Position: supine position. 2. Incision: Generally, the mid-abdominal incision is used. If necessary, it can be extended to the upper left to cut off the xiphoid and rib arch cartilage. The right inferior oblique incision can also be used, and the chest and abdomen combined incision is rarely needed. 3. Separation of the left half of the liver: Before removing the liver, the connective tissue and ligament attached to the left hepatic liver are separated. The liver ligament was first cut and ligated, and the liver was gently pulled down by the liver side stump, and the sacral ligament was cut along the anterior abdominal wall. Push the liver backwards and downwards to better expose and cut the coronary ligament, and ligature and cut the left triangular ligament on the dorsal side of the temporal surface. Then, the liver and stomach ligaments are cut and the hepatoduodenal ligament is cut (not to damage the liver pedicle), and the left half of the liver is separated. 4. Treatment of the hepatic hilum of the first hepatic hilum: After separating the liver, the liver is pulled upward with a large hook to reveal the first hepatic hilum. Sometimes to prevent major bleeding during the removal of the liver. It can be placed in the pedicle with a gauze strip or catheter to control blood flow. There are two common methods for treating hilar vascular: (1) External sheath ligation: the left hepatic duct, the left hepatic artery and the left branch of the portal vein were ligated together outside the glisson sheath. First, along the left and the lower of the glisson sheath, the 0.5cm area was bluntly separated and penetrated into the liver parenchyma about 1cm. Do not tear the blood vessels that travel inside the sheath when separating. After clear separation, 2 cm from the left side of the main branch of the portal vein, two lines are ligated with thick thread; can not be cut off temporarily, after the left hepatic parenchyma is completely disconnected, then verify whether the left stem is ligated correctly. Then, cut between the two knots, take the left liver, and dry the stump of the vessel for suture. (2) Intrathecal ligation: When the hilar vascular is abnormal, the glisson sheath should be separated, and the left hepatic duct, the left hepatic artery and the left branch of the portal vein should be ligated. The left hepatic duct and the left hepatic artery need to be cut off first, and the portal vein is not cut off temporarily, as a sign of the subsequent removal of the liver lobe. 5. Treatment of the left hepatic vein of the second hepatic hilum: After the first hepatic hilum treatment is completed, the liver is pulled downward to reveal the second hepatic hilum. At this time, it is necessary to first distinguish the anatomical relationship between the left hepatic vein and the middle hepatic vein. Sometimes the hepatic vein and the left hepatic vein are injected into the inferior vena cava respectively; sometimes the hepatic vein first merges into the left hepatic vein and then into the inferior vena cava. It should also be noted that the left hepatic vein is shorter in the extrahepatic part, and it is often necessary to cut the liver capsule to distinguish it. Slowly separate the left hepatic vein and the middle hepatic vein bifurcation with the back of the knife, retain the middle hepatic vein, and then use the blunt-tipped thick round needle to lead the thick thread, penetrate the liver parenchyma, ligature the left hepatic vein, then cut off and separate the second hepatic hilum. 6. Disengage the left half of the liver: cut the liver capsule 0.5 cm along the left side of the hepatic vein, and bluntly separate the liver parenchyma with the knife back, and then clamp the left hepatic vascular tube with a curved hemostat. Cut and ligature. Do not damage the trunk of the hepatic vein during this procedure. Then from the front edge of the liver to the liver parenchyma blunt separation, and finally cut the left branch of the portal vein, completely disconnected left liver. The blood vessels and liver tubes of the liver section should be ligated or sutured with a thin wire. The oozing can be stopped by hot saline gauze. 7. Omentum covering the liver section: Because the left hepatectomy has removed the hepatic sacral ligament, the section of the liver needs to be sutured with silk suture and covered with a small omentum or omentum suture to prevent intestinal adhesion. Helps stop bleeding. If there is still bleeding, the hemorrhoids should be sutured at the wound edge. After checking for no oozing or leaking bile, a cigarette drainage or double lumen drainage was placed in the left hepatic fossa and the retina hole, and the abdominal wall was sutured layer by layer. complication Reduced liver function.