关键词: 腹腔镜, 解剖性肝切除, 肝静脉

Abstract: Accident and treatment of hepatic vein access and exposure during laparoscopic hepatectomy        CHENG Wei, CHEN Shao-feng, LIU Yi. Department of Hepatobiliary Surgery, the First Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha 410005, China
Corresponding author: CHENG Wei, E-mail: 13974866177@163.com
Abstract    With the development of endoscopic technology, laparoscopic hepatectomy (LH) has been widely used in liver surgery. Its safety and effectiveness are equal to or even better than that of open surgery. Laparoscopic anatomic hepatectomy along hepatic vein is an anatomic hepatectomy with hepatic vein as the cutting plane. On the premise of ensuring the cutting edge, the liver tissue with normal function is retained to the maximum extent, reducing the residual of ineffective liver tissue without blood supply, and reducing the incidence of tumor recurrence and complications after operation. Hepatectomy via hepatic vein approach is one of the best methods to determine the resection plane and achieve anatomical hepatectomy. It is very important for anatomic hepatectomy to find and follow the shape of the landmark hepatic vein and to judge and correct the cross-sectional plane. The most difficult points of laparoscopic operation along hepatic vein are the anatomy and exposure of hepatic vein, the control and treatment of intraoperative hemorrhage. Laparoscopic anatomical hepatectomy along the hepatic vein has high requirements for the surgical field, operating space and anatomical exposure. Therefore, an appropriate hepatic resection approach is of great significance for the completion of laparoscopic hepatectomy along the hepatic vein. Currently, more used approaches are the anterior approach, the cephalic approach and the dorsal approach. The operator needs to choose different approaches according to his own operating habits and different liver segment resections. The soft and thin wall of the hepatic vein, many branches, easy to tear, large amount of blood return, and difficult exposure make it easy to damage the hepatic vein in the process of hepatectomy. Bleeding and gas embolism are two major complications caused by hepatic vein injury. Intraoperative bleeding is difficult to avoid in hepatectomy. The emphasis is on prevention. Once bleeding or gas embolism occurs, it must be calmly evaluated and treated in time to carry out laparoscopic hepatectomy more safely.

Key words: laparoscope, anatomical hepatectomy, hepatic vein