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Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.
ABSTRACT
Due to the theoretical and technique limitation of traditional surgery,surgical treatment of complex intrahepatic biliary diseases was left for an unresolved difficult problem of the last century.Uncertainties of the anatomical,physiological,pathological changes and surgical techniques in the intrahepatic biliary tract contribute to this complexity.Through integrated application of modern scientific technology and traditional medicine methods and systematic optimization and innovation of biliary surgical theories and techniques,authors have developed a paradigm of precision biliary surgery which is characterized by high quantification,visualization and controllability.The establishment of the precise biliary surgical system solves the difficulty in surgeries for intrahepatic biliary diseases,puts forward the biliary surgery from extrahepatic ducts,hilar ducts to intrahepatic ducts,entering a new segment era of the biliary surgery marked by precision treatment of intrahepatic biliary diseases.
ABSTRACT
Objective To study the regulation of iodine solution dissemination through the portal vein duo to compression of liver tissue in SD rat models.Methods SD rats were divided into three groups:liver segment blocking group,non-liver segment blocking group and placebo group.Right anterior segments of liver were blocked by blocking ribbon before the compression of liver tissue in liver segment blocking group,the liver tissue was pressed in 20 times.The procedures were all the same with blocking groups in non-liver segment blocking group except that the liver tissue is free from blocking.Placebo group only was opened and closed the abdomens.The iodine solution was injected into the liver tissue in right anterior segments and iodine ball should be confirmed under the X-ray in every experimental rats.The severity of the iodine predations in the liver was divided into four degree:Degree A indicated the iodine ball was in situ;no predations;Predations were in right anterior segments only in degree B;Degree C was found iodine spots in other liver segments except right anterior segments;Degree D indicated iodine spread to other organs.The iodine balls were pressed under the pressure between 10 and 15 mm Hg.Results Majority of iodine balls(36/45,80%)were formed successfully in liver tissues.Compression of the iodine balls in liver tissues can cause iodine predations in the vessels in liver.The severity of the dissemination was related to the pressure and the range of the pressings.The blocking of the liver segments before the operation can reduce the predations of iodine.Conclusion Pressing of the liver tissue can caused the iodine balls disseminate in vessels,cancer cells or cause thrombus disseminate in the vessels,Which can be reduced by avoiding the compression of the liver or tumom during the operation.