right hepatectomy

The right hepatic resection is a resection with the median fissure as the boundary, and the hepatic vein to the right of the liver, including the right anterior lobe, the right posterior lobe and the right segment of the caudate lobe, which account for about 3/5 of the whole liver. The gallbladder is often within the resection range. . In adults, because liver cancer has more cirrhosis, in order to ensure that there is enough normal liver after surgery, the right hepatic resection is gradually replaced by partial hepatectomy. In children, there is no cirrhosis, and the ability of liver regeneration is strong, and the tumor volume is often large. Therefore, right hepatectomy is still a common choice. The success rate of this operation is not high, because the liver is rich in blood supply, the structure is complex, and the cut surface is easy to bleed. Therefore, laparoscopic liver resection is slow, only a few large medical institutions have the ability to carry out, and the scope of resection is mostly limited to the left lateral lobe and liver. The lesions in paragraphs IV, V, and VI. Because of the difficulty and risk of laparoscopic right hepatectomy, mature laparoscopic hepatectomy and open hepatectomy are required to complete successfully. There are only a few successful reports abroad. Treatment of diseases: liver tumor liver cyst Indication 1. Liver malignant tumors: Children with hepatoblastoma are more common, occasionally rhabdomyosarcoma. Primary hepatocellular carcinoma can also be seen in older children, often with cirrhosis. Metastatic tumors are common in retroperitoneal neuroblastoma, nephroblastoma, and the like. Secondary tumors are surgical indications only if the tumor is confined to a certain leaf and the primary tumor can be resected. 2. Benign tumors: hepatic hemangioma, hemangioendothelioma, rare teratoma. 3. Liver cysts: Parasitic cysts are mainly liver hydatid, non-parasitic cysts are usually polycystic liver, and more common in the right lobe of the liver. If the cyst is limited to a certain leaf and the liver is severely damaged, it is suitable for liver resection. 4. Liver injury: severe liver damage, can not be repaired, or ruptured liver blood transfusion, suitable for liver resection. 5. Localized inflammatory lesions, which have a wide range of liver invasion and severe liver tissue damage, such as chronic bacterial liver abscess, liver tuberculosis, and chronic amoebic liver abscess. Preoperative preparation 1. The heart, lung, kidney, liver and other functions should be thoroughly examined before surgery to understand the systemic stress ability and liver reserve capacity of the sick child. 2. Give high protein, high carbohydrate and high cellulose diet before surgery. Actively improve anemia, improve the body's resistance in a short period of time, improve the blood coagulation mechanism, reduce intestinal bacteria, and give broad-spectrum antibiotics before surgery. 3. Children with trauma should actively resist shock and correct the imbalance of water and acid. 4. Place stomach tube and urinary tube before operation. Surgical procedure 1. Incision: The commonly used incision is a right inferior oblique incision. If necessary, it is extended to the right or left rib margin to meet any type of liver surgery without opening the chest. Straight cuts have been abandoned. When the probe determines the right hepatectomy, the right lobe of the liver must be completely removed, including the ligament of the liver, the sacral ligament, the right coronary ligament, the right triangular ligament, the hepatic colon ligament, and the liver and kidney ligament. In this process, care should be taken not to damage the diaphragm, the bare liver, the right adrenal gland and its blood vessels. 2. Separate the cystic duct, the cystic artery, and ligature and cut. Or remove the gallbladder first to reveal. The Glisson sheath was incised, and the right hepatic artery, the right branch of the portal vein, and the right hepatic duct were exposed and ligated and cut. 3. Turn the right hemi-hepatic to the left to reveal the posterior inferior vena cava and the right hepatic vein. The short hepatic veins must be carefully separated and ligated one by one. Because of its shortness, it is generally threaded and then cut. Exercise lightly to prevent tearing bleeding. 4. The right hepatic vein is deeply buried in the liver parenchyma, and the extrahepatic stroke is short and difficult to reveal. The hepatic capsule can be incision near the right hepatic vein, separated through the liver parenchyma, and ligated and cut with a right angle pliers. The safe way is to cut the liver and cut it in the liver. 5. After ligation of the right hepatic lobe of the liver to be resected, a clear boundary line of liver color change can be seen on the surface of the liver. The liver capsule was cut slightly to the right along this boundary line, and the liver parenchyma was bluntly separated by finger pressure or a shank, and the tube was clamped and ligated, including the right branch of the middle hepatic vein. Keep the trunk of the liver in the vein to avoid damage. If you have a lot of bleeding when you cut the liver, you can temporarily block the hilar. After right hepatectomy, the liver section was treated with left hepatectomy. complication Intraperitoneal hemorrhage Most of them are due to the detachment of the knot of the ligated blood vessel, or the hemostasis of the liver section is not complete, or the coagulation mechanism is disordered. After the application of hemostatic drugs, such as hemorrhagic shock, or a large amount of fresh blood in the drainage tube, in the case of active blood transfusion, timely exploration and hemostasis. 2. Upper gastrointestinal bleeding Stress ulcers can occur after liver surgery. It is manifested as bloody or brown gastric juice in the stomach tube. In severe cases, it can cause heart rate to increase and blood pressure to drop. Gastrointestinal decompression should be continued after surgery, and H2 receptor antagonists should be used. When bleeding is found, an antacid and a hemostatic agent can be injected into the stomach tube, and if necessary, somatostatin is applied. Surgical treatment should be performed for patients with major bleeding who are not treated by non-surgical treatment. 3. Liver dysfunction The function of the remaining liver should be carefully evaluated before and during surgery, and the liver should be actively treated after surgery. 4. Abdominal infection After the hepatic lobe is resected, although the section has stopped bleeding, there will still be exudation. If the drainage is not smooth, there will be secondary purulent infection. It is characterized by high fever and even toxic shock. Treatment with systemic antibiotics, repeated B-guided puncture and pus injection and antibiotics, as far as possible without surgical drainage. 5. timid Leakage of the bile duct from the liver section, loss of bile duct ligature or bile duct injury not found during surgery. Poor drainage can cause peritonitis. The drainage is good, and the fistula is formed, which is generally self-healing.

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