肝尾叶切除术
2009-9
Springer
彭淑牖
293
Although Couinaud's study of the anatomy of theliver in the 1950s marked the beginning of a newera in modem liver surgery; and in the 1970s， hugebreakthroughs in liver transplantation and regularresection of liver were made; nevertheless， it wasnot until the 1990s that caudate lobe resection wasfirst documented. In the last decade， through theefforts of both western and eastern scholars of liversurgery， reports involving resection of the caudatelobe have gradually emerged. Most of these，however， are confined to individuals and smallnumbers of cases. Therefore， resection of thecaudate lobe is considered by many experts as theultimate field in liver surgery.The caudate lobe is situated in a complexanatomical position. Namely， it is covered in frontby the first porta hepatis， with the inferior vena cava （IVC） at the back， and its upperend lying close to the three major hepatic veins. Therefore， resection of the caudatelobe presents huge difficulties and risks. In order to reduce the operating risks andtechnical difficulties， the earliest caudate lobe resections were conducted inconjunction with other types of liver resection， that is， massive liver resection thatincluded partial or complete caudate lobe. Advances in the applied anatomy of thecaudate lobe， the development of modem imaging technologies such as CT and MR/，improvements in surgical instruments and facilities， and progress in the techniquesof blood flow control and liver parenchymal transection， have all given much impetusto the development of hepatic caudate lobe surgery. It was not until 1990 when Lemtet al. reported isolated complete resection of caudate lobe. The anterior approachsuggested by Yamamoto et al.
Hepatic Caudate Lobe Resection provides a comprehensive and up-to-datecoverage of research on the surgical technique of caudate lobe resection.The book introduces all kinds of procedures for caudate lobe resection， frombasic ones to the most complex ones. A new surgical dissection techniqueusing a simple yet versatile instrument isi-duced， which is of great helpin facilitating the procedure and enhanring the safety of the operation.More than 350 pictures about the anatomy of the caudate lobe， the surgicalprocedure or special instruments are presented， and 18 different videosare demonstrated. It is a great reference for liver surgeons learning aboutcaudate lobe resection， as well as researchers and postgraduate students inthe fields of hepatobiliary surgery.Being an Honorary Fellow of American College of Surgeon and an HonoraryFellow of European Surgical Association， Dr. Shu You Peng is a professor atthe Second Affiliated Hospital， and the Sir Run Run Shaw Hospital， Schoolof Medicine， Zhejiang University， China.From pre-publication reviews:"This book， describing the most delicate hepatectomy in the center of the liver，will make easy the performance of the other hepatectomies of the left liver andthe right liver. It is a perfect introduction to the liver surgery. It is like doing theBechamel sauce: if you know it， all recipes will be easy."Professor Henri Bismuth， the founding President of ESA"This book is a 'must'for all liver surgeons who are interested to improve theirknowledge and skills in complicated liver surgery."Professor Wan Yee Lau， the past President of IHPBA.
1 Anatomy 1.1 Basic Knowledge 1.2 Portae Hepatis 1.3 Pedicle of the Caudate Lobe 1.4 Peng's Transection Line 1.5 Anatomical Bases of Caudate Lobe and Caudate Lobe Fossa References 2 Surgical Instrument and Dissection Technique 2.1 Peng's Multifunction Operative Dissector 2.2 Curettage and Aspiration Dissection Technique References 3 Surgical Procedures 3.1 Position 3.2 Incision 3.3 Mobilization of the Liver 3.4 Taping Vessels 3.4.1 Taping the IVC 3.4.2 Taping the Common Trunk of the MHV and LHV 3.4.3 Taping the RHV 3.5 Detachment from Surrounding Structures 3.5.1 Detachment from the IVC （the Third Porta Hepatis） 3.5.2 Detachment from the Hilum （the First Porta Hepatis） 3.5.3 Detachment from Neighboring Liver and Hepatic Veins （the Second Porta Hepatis） 3.6 Isolated Resection of the Caudate Lobe by the Anterior Approach 3.6.1 Indications 3.6.2 Surgical Procedure References 4 Approaches to the Caudate Lobe 4.1 Left-sided Approach 4.1.1 Purely Left Approach for Metastasis from Colonic Cancer 4.2 Right-sided Approach 4.3 Bilateral （Combined） Approach 4.3.1 Combined Approach for Metastasis from GallbladderCarcinoma 4.3.2 Isolated Complete Combined Resection for HCC 4.4 Anterior Transhepatic Approach 4.4.1 Anterior Transhepatic Approach for HCC （1） 4.4.2 Anterior Transhepatic Approach for HCC （2） 4.4.3 Anterior Transhepatic Approach （Split of the Upper Half of the Midplane） for Hemangioma 4.4.4 Anterior Transhepatic Approach for HCC （3） References 5 Classification of Caudate Lobe Resection 5.1 Isolated Complete Resection of the Caudate Lobe 5.1.1 Isolated Complete Resection of the Caudate Lobe for Angioleiomyolipoma （1） 5.1.2 Isolated Complete Resection of the Caudate Lobe for Angioleiomyolipoma （2） 5.1.3 Isolated Complete Resection of the Caudate Lobe for Hemangioma Mainly by Left Approach 5.1.4 Isolated Complete Resection of the Caudate Lobe by Combined Approach 5.1.5 Isolated Complete Resection of the Caudate Lobe for HCC （1） 5.1.6 Isolated Complete Resection of the Caudate Lobe for HCC （2） 5.1.7 Isolated Complete Resection of the Caudate Lobe for Solid Cystic Tumor 5.2 Isolated Partial Resection of the Caudate Lobe 5.2.1 Resection of the Caudate Process for HCC Closely Attached to the IVC 5.3 Combined Complete Resection of the Caudate Lobe 5.3.1 Combined with Left Lobe Resection for Hilar Cholangiocarcinoma 5.3.2 Combined with Left Lobe Resection for HCC 5.3.3 Combined with Left Lobe Resection for Cholangiocarcinoma with Thrombus 5.3.4 Left Lobe and Caudate Lobe Resection for HCC 5.3.5 Combined with the Right Lobe and IVC Resection for Cholangiocellular Carcinoma 5.4 Combined Partial Resection of the Caudate Lobe 5.5 Giant HCC Originating in the Caudate Lobe 6 Retrograde Resection of Caudate Lobe 6.1 Surgical Procedures 6.1.1 Mobilization of the Whole Liver 6.1.2 Detachment of the Caudate Lobe from the Liver 6.1.3 Detachment of the Caudate Lobe from the IVC 6.2 Summary References 7 Measures for Safe Resection of Caudate Lobe 7.1 Adequate Abdominal Incision 7.2 Taping of Major Veins 7.3 IVC Controlled with Fingers 7.4 Application of the Liver Hanging Maneuver 7.5 Application of Retrograde Resection 7.6 Using the Curettage and Aspiration Dissection Technique References 8 Laparoscopie Resection of Caudate Lobe 8.1 Entries， Position and Instrument 8.2 Retrograde Laparoscopic Spiegel Lobectomy Combined with Left Lateral Segmentectomy References Index
