Right hemihepatectomy through the right retrohepatic tunnel

Abstract

Objective To study the clinical value of anatomizing and ligating the short hepatic veins (SHVs) and right hepatic veins through the right Retrohepatic Tunnel (RT) in right hemibepatectomy of giant hepatic carcinoma.Methods We performed the right hemibepatectomy on 23 patients with huge tumors which diameters were lager than 8 cm.There were four main procedures during the operation.Firstly,sperated the interspace between right hepatic veins and middle hepatic veins through secundum porta hepatis.Secondly,seperated and ligated the right hepatic portal vein and hepatic artery in the Glisson's system.Thirdly,anatomized and ligated SHVs and right hepatic veins through the right RT conversly.Finally,set a blocking-belt at the left of the central liver and then cut the right hemi-hepar.Results The anatomy of right hepatic artery,Portal Vein,retrohepatic inferior vena cava (RHIVC),right hepatic veins was well done.The intraoperative blood loss of 7 patients was less than 400 mL,and 11 was 500-700 mL,2 was 800-1 000 mL,3 was 1 100-1 400 mL,and average was 640 mL.The hepatic function was changed in the third day afteroperation.The numerus of TBIL of 16 patients was 20-40 μmol/L,and 6 was 45-50 μmol/L,and 1 was 60 μmol/L.The numerus of ALT of 14 patients was 150-200 U/L,and 9 was 250-400 U/L.The numerus of AST of of 13 patients was 160-200 U/L,and 9 was 230-400 U/L,and 1 was 430 U/L.The numerus of GGT of 14 patients was 160-200 U/L,and 8 was 220-310 U/L,and 1 was 420 U/L.The hepaticfailure happened to 1 patient because of deep venous infection.Conclusions The right hemibepatectomy through the right retrohepatic tunnel is feasible in the tumor without invasion the RHIVC and diaphragm,or the volume was not too huge.The operation could reduce the blood loss and make for the recovery of hepatic funtions. Key words: Liver neoplasms; Retrohepatic Tunnel (RT) ; Vascular deligation; Hepatectomy; Therapies; Investigation