总结腹腔镜左肝优先原位模块化右半肝加尾状叶切除术治疗Ⅲa型肝门部胆管癌的经验。

回顾性分析2020年6月在河北医科大学第二医院肝胆胰腺外科进行腹腔镜左肝优先原位模块化右半肝加尾状叶切除术患者的临床资料。

患者顺利完成手术，手术时间390 min，术中出血量约600 ml，术中输注红细胞0.5 U、血浆600 ml。术后无出血、胆瘘、胃肠瘘、胆管狭窄等并发症，顺利出院。术后病理报告显示Bismuth Ⅲa型肝门部胆管癌。

腹腔镜左肝优先原位模块化右半肝加尾状叶切除术对于Bismuth Ⅲa型肝门部胆管癌是安全、可行的。优势：符合"no-touch"和"en-block"肿瘤外科基本原则，减少术中操作牵拉、挤压肿瘤；处理第三肝门和第二肝门时，助手向左侧牵拉左半肝可以有效增加手术操作空间，方便术者"考古式"显露、处理肝短静脉和右肝静脉。

To summarize our experience of laparoscopic left-liver-first anterior radical modular orthotopic right hemihepatectomy for Bismuth Ⅲa hilar cholangiocarcinoma(Lap-Larmorh).

The researchers recorded and analyzed the clinical data of patients undergoing this novel procedure at the Second Hospital of Hebei Medical University in Jun.2020.

The operation has been successfully performed. The operative time was 390 min, and the estimated blood loss was 600 ml. The blood transfusion occurred, and 0.5 U red blood cells and 600 ml plasma were required. The patient recovered well after surgery and did not have postoperative complications such as bleeding, bile leakage, gastrointestinal leakage, and biliary stricture. The pathological results confirmed the diagnosis of Bismuth Ⅲa hilar cholangiocarcinoma.

It is safe and feasible to perform Lap-Larmorh for Bismuth Ⅲa hilar cholangiocarcinoma. This novel procedure avoids traction and compression of the tumor and complies with the "no-touch" and "en-block" basic oncological principles. Compared to conventional right liver resection, Lap-Larmorh also has an extended operative space when dealing with the short hepatic vein and right hepatic vein by the assistant pulling the left liver to the patient′s left.