围肝门外科术前评估策略和术中处理技术(3)

4.5 放置引流管

围肝门区手术创面大,通畅的引流能减少腹腔积液,预防腹腔感染。引流管应放置于肝创面与胆肠吻合口后方的最低位,不要压迫肝动脉与门静脉。术后应定期复查B超或CT,以判断腹腔有无积液。在术后无胆漏、出血等情况下,尽早拔除引流管,以免继发腹腔感染。

5 小结与展望

围肝门外科技术因涉及的范围解剖结构复杂、所含疾病繁多及治疗决策差异较大,致使其成为一个繁复、危险与多变的外科技术。随着外科理念和技术的革新,围肝门外科将贯彻脉管优先、控制出血和把握极限点的外科原则,显著提高其实践的确定性、预见性和可控性。

参考文献

[1] 黄志强.围肝门外科与手术并发症[J].肝胆外科杂志,2001,9(6):401-402.

[2] 董家鸿,杨世忠,冯晓彬.论围肝门外科[J].中国实用外科杂志,2019,39(2):110-112.

[3] 王坚,陈炜.围肝门外科技术在胆道外科的应用[J].中华消化外科杂志,2015,14(4):284-287.

[4] 中华医学会外科学分会胆道外科学组,中国医师协会外科医师分会胆道外科学组.围肝门区域外科技术临床应用路径中国专家共识(2020 版)[J].中国实用外科杂志,2020,40(6):626-633.

[5] 中国研究型医院学会肝胆胰外科专业委员会.精准肝切除术专家共识[J].中华消化外科杂志,2017,16(9):883-893.

[6] OHKUBO M,NAGINO M,KAMIYA J,et al.Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation [J].Ann Surg,2004,239(1):82-86.

[7] ATRI M,BRET PM,FRASERHILL M,et al.Intrahepatic portal venous variations:prevalence with US [J].Radiology,1992,184(1):157-158.

[8] MICHELS N A,MICHELS N A.Newer anatomy of the liver and its variant blood supply and collateral circulation [J].Am J Surg,1966,112(3):337-347.

[9] YAN J,FENG H,WANG H,et al.Hepatic artery classification based on three-dimensional CT [J].Br J Surg,2020,107(7):906-916.

[10] 中国研究型医院学会肝胆胰外科专业委员会.精准肝切除术专家共识[J].中华消化外科杂志,2017,16(9):883-893.

[11] 董家鸿,郑树森,陈孝平,等.肝切除术前肝脏储备功能评估的专家共识(2011 版)[J].中华消化外科杂志,2011,10(1):20-25.

[12] IMAMURA H L.Assessment of hepatic reserve for indication of hepatic resection:decision tree incorporating indocyanine green test[J].J Hepatobiliary Pancreat Surg,2005,12(1):16-22.

[13] YOSHIOKA Y,EBATA T,YOKOYAMA Y,et al."Supraportal" right posterior hepatic artery:an anatomic trap in hepatobiliary and transplant surgery[J].World J Surg,2011,35(6):1340-1344.

[14] SUGIURA T,NAGINO M,KAMIYA J,et al.Infraportal bile duct of the caudate lobe:a troublesome anatomic variation in right- sided hepatectomy for perihilar cholangiocarcinoma[J].Ann Surg,2007,246(5):794-798.

[15] 戴朝六,贾昌俊.肝门板解剖的临床意义和应用[J].中国实用外科杂志,2019,39(2):122-126.

[16] SUGIOKAA,KATOY,TANAHASHIY.Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec′s capsule:proposal of a novel comprehensive surgical anatomy of the liver[J].J Hepatobiliary Pancreat sci,2017,24(1):17-23.

[17] KIGUCHIG,SUGIOKAA,KATOY,et al.Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position[J].Surg Oncol,2019,29:140-141.

[18] KIGUCHIG,SUGIOKAA,KATOY,et al.Laparoscopic S7 Segmentectomy using the inter-Laennec approach for hepatocellular carcinoma near the right hepatic vein[J].Surg Oncol,2019,31:132-134.

[19] HUY,SHIJ,WANGS,et al.Laennec′s approach for laparoscopic anatomic hepatectomy based on Laennec′s capsule[J].BMC Gastroenterol,2019,19(1):194.

[20] INOUE K,MAKUUCHI M,TAKAYAMA T,et al.Long- term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma[J].Surgery,2000,127(5):498-505.

[21] ABBAS S,SANDROUSSI C.Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar holangiocarcinoma[J].HPB Surg,2013,15(7):492-503.

[22] CHEN W,KE K,CHEN Y L,et al.Combined portal vein resection in the treatment of hilar cholangiocarcinoma:a systematic review and meta- analysis[J].Eur J Surg Oncol,2014,40(5):489-495.

[23] NAGINO M,NIMURA Y,NISHIO H,et al.Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma:an audit of 50 consecutive cases[J].Ann Surg,2010,252(1):115-123.

百度搜索“77cn”或“免费范文网”即可找到本站免费阅读全部范文。收藏本站方便下次阅读，免费范文网，提供经典小说医药类围肝门外科术前评估策略和术中处理技术(3)在线全文阅读。