基于Laennec膜指引多次肝脏手术后肝周粘连分离

doi:10.3877/cma.j.issn.1674-6899.2023.04.009

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (04): 243 -245. doi: 10.3877/cma.j.issn.1674-6899.2023.04.009

临床技术

基于Laennec膜指引多次肝脏手术后肝周粘连分离

彭进, 岳扬, 余德才^†(

)

210008　江苏，南京大学医学院附属鼓楼医院普通外科肝胆与肝移植外科

收稿日期:2023-05-11 出版日期:2023-08-30
通信作者: 余德才

Laennec capsule based the separation of perihepatic adhesions after hepatic surgeries during laparoscopic hepatectomy

Jin Peng, Yang Yue, Decai Yu^†()

Department of Hepatobiliary Surgery and liver transplantation surgery, The Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Jiangsu 210008, China

Received:2023-05-11 Published:2023-08-30
Corresponding author: Decai Yu

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目的

证实基于Laennec膜指引多次肝脏手术后行肝周粘连分离的优势。

方法

选取典型多次肝脏手术患者，经Laennec入路行肝周粘连分离，展示膈下，肝下及裸区的粘连分离。

结果

多次肝脏术后患者肝周粘连经寻Laennec膜行粘连分离，层次清晰，出血少，副损伤小。

结论

基于Laennec膜指引多次肝脏手术后肝周粘连分离安全可行，可作为多次肝脏手术后肝周粘连分离的手术入路。

关键词: 肝脏游离, Laennec膜, 肝周粘连

Objective

To proove the advantage of Laennec membrane-based guidance in the separation of perihepatic adhesions after multiple liver operation.

Methods

The adhesions were isolated from the subphrenic, subhepatic and naked areas through Laennec approach in patients with multiple liver surgery.

Results

The adhesions were separated by Laennec membrane after several liver operations. The layers of adhesions were clear, the bleeding was less and the side injury was less.

Conclusions

Laennec membrane is a safe and feasible approach for the separation of perihepatic adhesions after multiple liver operations.

Key words: Liver dissociation, Laennec membrane, Perihepatic adhesion

图1 Laennec入路行膈下游离注：A.超声刀常规分离膈下粘连；B.沿Laennec膜分离膈肌与左肝表面粘连；C.沿肝表面Laennec膜钝性分离右肝与膈肌粘连；D.沿Laennec膜分离膈下脂肪组织与肝脏表面的粘连。

图2 Laennec入路行肝下游离注：A.常规游离肝下与右侧肾上腺之间的粘连；B.沿Laennec膜分离肝脏与肝蒂之间的粘连；C.沿Laennec膜游离右肝蒂；D.沿Laennec膜游离左肝蒂。

图3 Laennec入路行裸区游离注：A.Laennec入路分离裸区与膈肌之间的粘连；B.Laennec入路钝性分离裸区与膈肌之间的粘连

1	Ishizawa T, Kokudo N, Makuuchi M. Right hepatectomy for hepatocellular carcinoma: is the anterior approach superior to the conventional approach？[J]. Ann Surg, 2008, 247(2)：390-391; author reply 391-392.
2	Rotellar F, Pardo F, Martí-Cruchaga P, et al. Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it[J]. Langenbecks Arch Surg, 2017, 402(1)：181-185.
3	Hu Y, Shi J, Wang S, et al. Laennec′s approach for laparoscopic anatomic hepatectomy based on Laennec′s capsule[J]. BMC Gastroenterol, 2019, 19(1)：194.
4	Pu Q, Zhang C, Huang Z, et al. Reoperation for recurrent hepatolithiasis: laparotomy versus laparoscopy[J]. Surg Endosc, 2017, 31(8)：3098-3105.
5	Cao J, Chen YJ. Discussion on the approach of laparoscopic hepatectomy[J]. Chinese Journal of Surgery, 2019, 57(7)：503-507.
6	Kiguchi G, Sugioka A, Kato Y, 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.
7	李振华，杨颖，罗倩，等. 开腹术后腹腔镜肝切除术手术入路选择[J]. 肝胆外科杂志，2019, 27(5)：368-370.

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[2]	周后平, 袁源, 欧廷政, 李贝贝, 尚明铭, 姚本能, 宋新, 罗雪梅. 胆囊板Laennec膜间隙逆行分离联合Pringle法在困难胆囊LC术中应用（附视频）[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 540-544.

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Laennec capsule based the separation of perihepatic adhesions after hepatic surgeries during laparoscopic hepatectomy

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Laennec capsule based the separation of perihepatic adhesions after hepatic surgeries during laparoscopic hepatectomy