Surgical method and instrument for two-step excision of patient side liverby liver winding belt method under complete laparoscope

A laparoscopic and surgical technique, applied in the fields of surgery, medical science, diagnosis, etc., can solve the problems of high incidence of bile leakage, poor recovery of physical strength, and increased adhesion in the abdominal cavity, so as to achieve less surgical trauma and reduce body immunity. The effect of the system's blow

Active Publication Date: 2021-11-30
ZHEJIANG UNIV
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

However, there are still some problems in this operation, the most prominent of which is that the first operation needs to cut and separate the left and right livers to block the communication blood flow between the left and right hemi-livers. The risk of bile leakage in the liver section is extremely high. Regensburg Hospital, Germany, the incidence of bile leakage in this operation is as high as 24%
In addition, if the interval between the two operations is too long, it will easily lead to increased adhesions in the abdominal cavity. second stage surgery

Method used

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  • Surgical method and instrument for two-step excision of patient side liverby liver winding belt method under complete laparoscope
  • Surgical method and instrument for two-step excision of patient side liverby liver winding belt method under complete laparoscope
  • Surgical method and instrument for two-step excision of patient side liverby liver winding belt method under complete laparoscope

Examples

Experimental program
Comparison scheme
Effect test

Embodiment 1

[0054] 1 clinical data

[0055] Patient, female, 61 years old. He was admitted to the hospital because of "found that AFP increased for 5 days". Past history: Suffering from chronic hepatitis B for 30 years, long-term follow-up and antiviral treatment with lamivudine and adefovir dipivoxil. "Open right hepatic nodule resection + cholecystectomy" was performed in another hospital 2 years ago, and the postoperative pathology showed coarse nodular cirrhosis and chronic atrophic cholecystitis. Admission examination: height 156cm, weight 47kg. Liver disease face, no liver palms and spider nevus, no yellow staining of skin and sclera. The abdomen was soft, without tenderness and rebound pain. After admission, the laboratory test AFP was 39.94 μg / L. Liver function Child grade A grade. Enhanced CT of the upper abdomen revealed: hepatic segment II space-occupying lesion, liver cancer, liver cirrhosis, splenomegaly, absence of gallbladder, slightly dilated intrahepatic bile duct. ...

Embodiment 2

[0075] The patient underwent "liver radiofrequency ablation" for liver cancer in a hospital in Beijing 2 years ago. After the operation, he had no obvious complaints of discomfort. The alpha-fetoprotein was checked every 3 months, and the results were normal. He entered our department for TACE two months ago, and has felt discomfort in the upper right abdomen since the operation, but has no other obvious abnormalities. Now, for further treatment, he came to our hospital for treatment. The patient suffered from chronic hepatitis B for 16 years and took 1 adefovir tablet QD.

[0076] The residual liver volume calculated by preoperative CT accounted for 35.6% of the standard liver volume. Because the remaining liver volume of cirrhotic patients is required to reach more than 40% in the future, it is planned to perform laparoscopic two-step hepatectomy around the liver band to remove the right hemi-liver.

[0077] The first phase of surgery was performed on May 22, 2014: no obvio...

Embodiment 3

[0084] This example introduces the special instrument for the two-step laparoscopic resection of the liver on the affected side according to the present invention, which is a pressure-adjustable liver tightening device.

[0085] Figure 8- Figure 12 The reference numerals in are: abdominal cavity 1, abdominal wall 2, external body 3, liver 4, liver band 5 (including first ratchet 51, base 52), abdominal wall catheter 6, pressure control device 7; pressure control device 7 includes a card Buckle 71, first sleeve 72, spring 73; buckle 71 includes second ratchet 711, second inner hole 712, protrusion 713, vernier 714; first sleeve 72 includes first inner hole 721, guide groove 722 , Scale 723.

[0086] It is a special instrument for implementing the laparoscopic two-step laparoscopic resection of the liver on the affected side. It is a pressure-adjustable liver tightening device, which includes the liver belt 5 made of flexible materials and the liver belt 5. One end is a free ...

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Abstract

The invention relates to a surgical method for two-step excision of a patient side liver by a liver winding belt method under a complete laparoscope, which comprises the following steps that: (1) a patient undergoes complete laparoscopic surgery in a general anesthesia state, the liver winding belt method is used for ligating a portal vein branch of the to-be-excided patient side liver, meanwhile, a liver winding belt is used for tightening the connecting portion between the left liver and the right liver to block traffic blood flow between the to-be-excided patient side liver and the to-be-reserved half side liver, after an abdominal cavity drainage tube is reserved at the portal of the liver, the abdomen is closed, and the first operation is completed; (2) after the first operation, the patient gradually recovers diet and recures for 6-15 days, so that the volume of theto-be-reserved half side liveris increased to the expected residual liver volume which is 30-40% or above of the standard liver volume; and (3) after the volume of the to-be-reserved half side liverof the patient is increased to the expected residual liver volume, a second operation is performed, a complete laparoscopic operation under general anesthesia is performed to excide the half-side liver of the patient, and the patient recures until complete rehabilitation. The invention further discloses a pressure-adjustable liver tightening device special for the surgical method.

Description

technical field [0001] The invention relates to an operation method and an operation instrument for resecting the liver of the diseased side under complete laparoscope two-step method for liver cancer patients with severe liver cirrhosis or liver tumor. Background technique [0002] In recent years, two-step hepatectomy combined with liver transection and portal vein ligation (ALPPS) has gradually attracted the attention of the hepatobiliary surgery community. This second surgery approach performs liver resection in patients who are considered unresectable. In the first stage of surgery, the portal vein branch of the liver to be resected is cut off, and the left and right livers are cut and separated at the same time. The volume of the retained liver will increase rapidly after surgery. A second-stage surgery is then performed to remove the liver on one side of the lesion. Judging from the current experience, this surgical method can perform hepatic resection for patients ...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): A61B17/00A61B17/12
CPCA61B17/00234A61B17/12013A61B2090/064A61B2090/0811A61B17/320068A61B17/1285A61B17/1325A61B17/1327A61B2017/00407A61B2017/12004
Inventor 蔡秀军彭淑牖王一帆陆琛陈鸣宇
Owner ZHEJIANG UNIV
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