腹腔镜肝切除术肝实质分离和断面处理技术

1、腹腔镜肝切除术肝实质分离和断面处理技术1991年Reich首先报道腹腔镜肝脏切除术2021年11月全世界英文文献共计报道2804例随着经历的不断积累手术技巧的不断提高新型器械的不断出现腹腔镜技术在肝脏外科的应用日渐广泛1991：Reich 报告首例1994：周伟平报告3例2004：嵇振岭国外报告22例2006：李荣报告123例2007：国内300例左右2021：蔡秀军200例多2021：国内文献43篇2021：国内文献39篇2021：国内文献33篇gapbeginningincreasingAuthorsInstitutesReport YearsCase numbersContributio

2、ns周伟平上海东方肝胆医院19943国内首先报道李朝龙广州南方医院19964林建华广州南方医院200110王存川暨南大学附属医院200210蔡秀军浙大邵逸夫医院200420嵇振岭东南大学中大医院200425首次在国外报道彭承宏上海交大瑞金医院200522肖震宇华中科技同济医院200520微波刀胡三元山东大学齐鲁医院20065李 荣北京301医院2006123大综病例 蔡秀军浙大邵逸夫医院2008200PMOD 腹腔镜肝切除技术及进展.中国微创外科杂志.2002;2 (1):58-60腹腔镜超声检查在LC术中的应用.中华肝胆外科杂志.2002;8(10):639-640腹腔镜多功能手术解剖器在实

3、验性肝切除术中的医用.实用临床医药杂志.2003;7(5):434-436腹腔镜外科中的组织别离技术.实用临床医药杂志. 2003;7(5):437-440Hepatic resection for metastasis from colorectal cancer. Tech Coloproctol 2004;8(s):4749A Laparoscopic Multifunctional Operative Device in Laparoscopic Hepatectomy. Chirurgische Gastroenterologie 2004;20: 308-312腹腔镜肝切除术6例报

4、告.中国微创外科杂志.2005;5(1):23-24腹腔镜肝切除12例报告.中华消化内镜杂志.2005;22(1):44-45腹腔镜多功能操作杆：ZL2003202102161.2. 实用新型专利. 2004年12月1日国际会议演讲2nd CCIHPBA, Wuhan, Oct 14-17,20065th BIC, Wiesbaden, Oct 1-5,20073rd IEHS, Stuttgart, Jan 16-19,2021CASC2021,Hong Kong, May 12-16,2021肝脏外科:无血解剖性切肝模式时代For safe laparoscopic hepatectomy

5、, it is important to have all necessary equipment. the intraoperative laparoscopic ultrasonographymicrowave coagulatorsultrasonic dissectionargon beam coagulatorslaparoscopic coagulation shearsendolinear staplersTissueLink monopolar sealerKaneko H, et al: Application of devices for safe laparoscopic

6、 hepatectomy HPB, 2021, 10(4): 219 - 224 Mono/Bipolar cauteryLigasure /ERBE BiclampHabib SealerPK cutting forceps TissueLink LMOD/PMOD切肝费时凝固组织厚坏死组织多继发感染近肝门及下腔静脉处不宜使用Curro G，Ann Surg, 2021, 250( 2): 229-233Biclamp Vessel SealingERBE安速PTCERBE Biclamp forcepsLigaSure Velectrothermal bipolar vessel devi

7、ce (EBVS)Tyco Valleylabthe laparoscopic Habib Sealer，LHS, AngioDynamics, Queensbury, NY that consists of a 22 array of needles arranged in a rectangle uses bipolar radiofrequency (RF) energywith a parenchyma transection time being 61 23 min.Dulucq JL, Surg Lap End & Pert Tech,2007, 17(5): 413-415Jia

8、o LR, Surgery 2021;144:770-4Vapor plasma coagulation cutting forceps (PK system cutting Forceps, Plasma Kinetic-PK System, Gyrus Medical, Maple Grove, MN, USAgenerates up to 200 W of radiofrequency output，with variable amplitude between 320 and 450 kHz. Abouljoud MS, et al. New application of the bi

9、polar vapor plasma coagulation system for laparoscopic major liver resections. Surg Endosc,2021, 22:426429saline-enhanced cooled cauterycouples radiofrequency with a conductive fluid to seal liver tissue to precoagulate parenchyma and isolate intrahepatic structures.Nissen NN, Am Surg, 2007, 73(10):

10、 987-990 集刮碎、钝切、吸除、冲洗与电凝功能于一体彭淑牖：PMOD蔡秀军：腹腔镜PMOD嵇振岭：LMOD万能杆Ji ZL et al. Chir Gastroenterol 2004;20:308-12Cai XJ et al. Chin J Min Inv Surg 2004; 19(2):71-3Cavitron Ultrasonic Surgical Aspirator (CUSA超声别离刀an ultrasonic dissectorflush 4 ml/min at 23 kHz and 70-W cautery Ultrasonic Shears别离、切割、凝血和抓持3 m

11、m 以下血管, 可先凝后切频率55.5 kHz, 振幅50100 mMicrowave / LaserWater-jet cutterLinear CutterThe 1064-nm Nd:YAG laser 1318-nm Nd:YAG laser. Chopra SS，PhotoMed Laser Surg, 2021, 27(2): 281-286Microwave Coagulator报道少见produces a pressurized water jet (3040 bar), washes the soft liver tissue, leaving only more resis

12、tant vessels and bile duct that are then ligated or clipped. 使用水喷刀时,腹腔内会产生水雾,影响摄像效果防水腹腔镜(hydro laparoscope) ,可在使用水喷刀时清晰摄像,提高了手术的平安性ERBE螺旋水刀Hironori Kaneko, et al. Hepatic resection using stapling devices. Am J Surg, 2004, 187: 280284腔镜下缝合同常规开腹肝切除术困难繁琐且易损伤周围组织可采用8 字缝合法止血缝合也可以用于阻断肝脏血流氩气流27L/min ,喷头距切面

13、1cm 以上, 在肝切面形成3mm厚焦痂, 直径小于2mm血管凝固, 快速止血腔镜下注意防止气栓Toru Ikegami, et al. Argon gas embolism in the application of laparoscopic microwave coagulation therapy. J Hepatobiliary Pancreat Surg (2021) 16:394398ERBE VIO外科工作站肿瘤定位肝脏游离血流阻断实质别离断面处理标本取出trocar positionlaparoscopic view of a tumorcavaThird porta hepatisDissection of the ligamentsRegional hepatic blood inflow occlusionAbsorbable clipa. transection by Harmonic Ultracisionb. transection by PMODc. Transection by LMODJi ZL et al. Chir Gastroenterol 2004;20:308-12Cai XJ et al. Chin J Min Inv Surg 2004; 19(2):7