Name: application of hemostatic devices in laparoscopic hepatectomy
Uploaded: 2022-04-19T13:00:00
Description: Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

这项工作得到了广州市科技项目（202102010090）的资助。

该操作是例行的，并获得了道德认证。批准如下：广州医科大学附属第二医院临床研究与应用伦理委员会批准快速评审：科研伦理评审项目“简易易用止血装置在腹腔镜肝切除术中的应用”（受理号：2022-hg-ks-02）经广州医科大学附属第二医院临床研究应用伦理委员会批准。其研究内容和方法符合医学伦理规范和要求。
1. 术前准备、手术体位和麻醉
<ol><li>要求患...

<ol>
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肝切除术是原发性肝癌和继发性肝癌患者最重要的治疗方法之一。1991年，Reich等人应用腹腔镜切除肝脏良性肿瘤，并完成了世界上第一个腹腔镜肝切除术4。经过多年的快速发展和推广，腹腔镜肝切除术已成为治疗肝恶性肿瘤的主流方法之一，近年来得到了广泛的应用。该技术具有术中出血少、术后疼痛少、术后并发症发生率低、住院时间短等优点，该技术的可行性和安全性得到...

肝细胞癌是消化系统中最常见的恶性肿瘤之一。根据原发部位的不同，可分为原发性肝细胞癌和继发性肝癌。细胞可以从原发性肿瘤以各种方式从肝脏外的器官转移到肝脏，导致肝脏癌。据报道，肝脏中超过50%的转移细胞来自结直肠癌，而其他则来自乳腺，胰腺，肺和胃肿瘤等1。近年来，继发性肝癌的治疗方法很多，包括系统化疗、介入治疗、分子靶向治疗、手术等2.然而，根治性切除术仍然是最有效的治疗方法，因为它可以完全切除癌症3。
随着腹腔镜技术的飞速发展，腹腔镜解剖肝切除术逐渐被外科医生所认可，但仍未得到广泛应用，特别是在基层医疗机构。其中一个原因是需要高档止血装置。这些都是降低手术过程中出血和胆汁泄漏风险所必需的。在这里，我们提出了一套简单易行的止血设备，包括单腔导管，谐波手术刀和单极电凝术，用于进行腹腔镜肝切除术。为此，首先使用单腔导管间歇性地闭塞肝门。然后使用谐波手术刀切除肝实质组织。出血点通过单极电凝点对点凝。这种简单易行的止血设备使用单腔导管进行刺炙操作，并利用谐波手术刀和单极电凝术的止血。这些设备可以在医院轻松找到，从而为进行腹腔镜检查或培训提供了额外的便利。因此，这些简单易用的止血装置适用于在初级医疗机构中进行手术。
在这项研究中，患者是一名67岁的男性，被诊断患有肝脏中转移的乙状结肠中度分化腺癌。2021年1月进行了乙状结肠癌的根治性切除术。病理结果为中度分化腺癌，TNM分期为pT4aN2aM1。手术后给予四次FOLFOX化疗。在此之后，患者的身体状况被认为适合进行腹腔镜解剖肝切除术，以完全切除肝转移的病变。儿童-皮尤肝功能等级为A级。对于肝储备功能试验，ICG清除率试验中的R15为1.6%（<10%）。CT显示57 mm x 68 mm x 76 mm肿瘤横跨肝脏S5的背侧和S6的腹侧部分;三维重建模型如图 1所示。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>HARMONIC ACE Ultrasonic Surgical Devices</td>
			<td>Ethicon Endo-Surgery,LLC</td>
			<td>HAR36</td>
			<td></td>
		</tr>
		<tr>
			<td>Hem-o-lock</td>
			<td>Teleflex Medical</td>
			<td>544233</td>
			<td></td>
		</tr>
		<tr>
			<td>Monopole Electrocoagulation</td>
			<td>KANGJI MEDICAL</td>
			<td>/</td>
			<td></td>
		</tr>
		<tr>
			<td>single lumen ureter</td>
			<td>WELL LEAD MEDICAL CO.,LTD.</td>
			<td>12F</td>
			<td></td>
		</tr>
	</tbody>
</table>

application of hemostatic devices in laparoscopic hepatectomy

腹腔镜肝切除术被认为是治疗良性和恶性肝脏疾病的常规方法，因为它是一种微创方法。尽管具有非侵入性方面，但出血和胆汁渗漏发生在手术期间或术后肝实质组织切除术中，表明需要高级别止血装置，如超声手术抽吸，双极电凝等。这些高级止血装置的可用性不足，阻止了腹腔镜肝切除术成为基础医疗机构的普遍手术。针对上述情况，该方案开发了一套简单易行的止血装置，包括谐波手术刀、单极电凝和单腔导管，以创新方式进行肝实质组织切除术。首先，用单腔导管间歇性地闭塞肝门或肝椎弓根，然后夹紧15分钟并释放5分钟。随后，使用谐波手术刀，对肝脏进行钳夹和粉碎，以切断肝实质组织并揭示肝内动脉，静脉和胆管。最后，在每个点使用单极电凝来凝固出血点。利用这些方法可见肝内管路结构，可容易止血，降低胆汁渗漏发生率，提高腹腔镜肝切除术的安全性和可行性。因此，这里显示的简单易用的止血装置适用于初级医疗机构进行手术。

手术在2.5 h内完成，术中出血量为100 mL，未输血。无短期并发症，术后第8 天出院。操作后癌胚抗原（CEA）水平从操作前的1058.69μg/L降至110.64μg/L（图12）。手术后两个月，患者返回医院继续化疗（化疗方案为mFOLFOX6）。根据肿瘤病理结果进行化疗方案，如图 11所示。将患者返回医院复查时进行的CT检查与手术前进行的CT检查进行比较。没有观察到...

Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

Application of Hemostatic Devices in Laparoscopic Hepatectomy

高级止血装置对于腹腔镜肝切除术至关重要。然而，这些设备在基础医疗组织中并不普遍。因此，本文展示了一套简单易行的止血装置，可以使腹腔镜肝切除术更容易进行。

止血装置在腹腔镜肝切除术中的应用

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. ...

该技术的主要优点是止血装置简单易获得，可以在基础医院进行。这套止血设备可进一步应用于腹腔镜肝切除术等系统。强烈建议有一定的腹腔镜手术基础，特别是熟练使用谐波手术刀将这套止血装置应用于腹腔镜肝切除术。首先在腹腔镜检查中应用直接穿刺以建立气腹。在脐下区域，肋缘下方的右锁骨中线和腹侧中线的每个观察孔中放置一个10毫米的穿刺器。然后将一个五毫米的穿刺器放在右前辅助线和腹侧中线。从谐波手术刀、单极电凝和单腔导管开始组装止血装置，以创新方式用于肝实质组织切除术。要执行普林格尔操作，请使用单腔导管间歇性地闭塞第一个肝门。用止血夹夹住腔导管15分钟，然后使用谐波手术刀将其松开5分钟，切断夹子并将夹子取出以恢复第一个肝门的血液供应。分离供应肿瘤的肝椎弓根。用谐波手术刀将它们逐个切除。观察肝表面的缺血线，在肝蒂切除后变得可见。使用钩子标记它。使用谐波手术刀切除肝实质组织，同时逐渐夹紧和压碎肝脏。观察肝内动脉、静脉和胆管。切除和分割这些管线结构。一旦出现出血，立即使用点对点单极电凝术凝固肝清扫表面上的出血点。使用右肝后蒂作为肝内实质组织切除术的路标。保留主要的肝后椎弓根并解剖供应肿瘤的椎弓根分支。要完成手术，请清洗肝脏表面，以便查看是否仍有出血点。止肝清扫表面出血，从腹腔中取出肿瘤标本。操作在2.5小时内完成。术中出血量为100毫升，未输血，未观察到短期并发症。术后癌胚抗原水平从术前每升1058.69微克降至每升110.64微克。根据肿瘤病理结果，手术后两个月恢复化疗治疗。术后CT检查与术前CT比较，未观察到肿瘤再生迹象。手术过程中最重要的一步是使用谐波手术刀。需要大量的技能来避免对重要结构的损坏。

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Highly coordinated DNA repair pathways exist to detect, excise and replace damaged DNA bases, and coordinate repair of DNA strand breaks. While molecular ...

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

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In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery ...

The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

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