RESULTS: This video shows aA 37-year-old man was recommended treatment for a progressively increasing HCA (from 3 to 10 cm in a year) involving the right hepatic vein (RHV), inferior vena cava (IVC) and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers in CT. Laparoscopic hepatectomy was performed using the hepatic vein as anatomic markers in a treatment centre specialising in minimally invasive surgeries. The procedure involved fully mobilising the right liver, transecting the parenchyma along the demarcation line in the caudal-to-cranial direction, exposing the involved caudal MHV, isolating and transecting the involved RHV and preserving the integrity of the involved IVC.
CONCLUSIONS: Laparoscopic hepatectomy for intractable GHCA using the involved intrahepatic anatomic markers is feasible and effective. It reduces pre-operative haemorrhage and open conversion rates while maximising postoperative hepatic function.
结果:该视频显示,一名37岁的男性被推荐治疗涉及右肝静脉(RHV)的HCA逐渐增加(每年从3到10厘米),下腔静脉(IVC)和肝中静脉(MHV),导致上述肝内解剖标志物在CT中不可见。在专门从事微创手术的治疗中心,使用肝静脉作为解剖标记进行了腹腔镜肝切除术。这个过程包括充分调动右肝,沿分界线从尾到颅方向横切薄壁组织,暴露涉及的尾部MHV,分离和横切受累的RHV,并保持受累IVC的完整性。
结论:使用肝内解剖标志物对难治性GHCA进行腹腔镜肝切除术是可行和有效的。它可以减少术前出血和开放转换率,同时最大限度地提高术后肝功能。