Hepatic trisegmentectomy and other liver resections.

作者：Thomas E. Starzl, Richard H. Bell, Robert W. Beart, Charles W. Putnam · 发表于：PubMed · 年份：1975 · 被引用次数：194 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Organ Transplantation Techniques and Outcomes、Cholangiocarcinoma and Gallbladder Cancer Studies

Trisegmentectomy, extended right hepatic lobectomy, is the removal of the true right lobe of the liver in continuity with most or all of the medial segment of the left lobe. Some important features of the operation have not been well described previously. To perform trisegmentectomy safely, a fusion of liver tissue covering the umbilical fissure at the level of the falciform ligament must first be split open in many patients. The left branches of the portal triad structures are mobilized from the undersurface of the liver nearly to but not into the umbilical fissure. The blood supply and duct drainage of the medial segment originate within the umbilical fissure and feed back toward the right side buried in liver substance. They are found with blunt dissection just to the right of the falciform ligament, encircled and ligated. Failure to appreciate this switch back anatomic arrangement may lead to injury of the blood supply or biliary drainage of the residual lateral segment. Parenthetically, the mirror image operation of lateral segmentectomy could result in devascularization of the medial segment if dissection and ligation were performed within the umbilical fissure instead of well to the left of this landmark. In most trisegmentectomies, the left portion of the caudate lobe is not removed. This small piece of tissue is interposed between the lateral segment and the inferior vena cave into which it drains by small tributaries. If the left portion of the caudate lobe is to be...