Because the right posterior lobe liver is located behind the costal arch, it is like hiding in a “cave”, so the resection of the right posterior lobe liver tumor has always been a difficult operation. pocket”, the operation is even more difficult.
Recently, a team of experts from the Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, took a different approach and used 3D laparoscopy to perform surgery on a man with right posterior lobe liver tumor complicated with scoliosis.
The patient was discharged from the hospital on the 5th postoperative day after using the enhanced recovery surgery strategy. The unique “problem-solving idea” of the expert team is highly praised by patients and their families.
[Preoperative imaging showed: scoliosis, thoracic deformity, special location of liver tumor, increased difficulty in surgery]
64 Mr. Su (pseudonym), a man from Yueyang, Hunan, suffered from “scoliosis” since childhood. He underwent laparotomy for stomach hemorrhage more than 10 years ago. strong>bladder stones” was treated in a local hospital, and a “space-occupying lesion” was found in the lower segment of the right posterior lobe liver during abdominal CT.
Because of the congenital deformity of the thoracic cage and spine, after consulting many hospitals, they were told that the operation is too difficult, and it is recommended to choose the operation carefully.
For further treatment, Mr. Su came to Hunan Provincial People’s Hospital Hepatobiliary Surgery on March 18, 2022.
[Intraoperative field of view before specimen resection]
After admission, Vice President of Hepatobiliary Hospital, Director of Hepatobiliary Surgery Department Prof. Mao Xianhai, who is also the director of the Third Department of Hepatobiliary Department, organized a team to conduct detailed preoperative discussions and agreed that the patient had a clear diagnosis of liver cancer and clear indications for surgery, but there were multiple unfavorable factors affecting the surgery:
1. The tumor is located in the right posterior lobe of the liver, which is difficult to reveal. Due to scoliosis and thoracic deformity, the operation is performed in a “cave”, and the operation space is very limited;
2. The patient has hepatitis C and liver cirrhosis, and the tumor is exposed, which increases the intraoperative bleeding and tumor The risk of rupture brings uncertainty to the surgical operation;
3. The patient is only 1.5 meters tall, has a history of abdominal surgery, and the original surgical site is adherent, which increases the difficulty of the surgical operation.
[Intraoperative field of view after specimen resection]
In the past, open surgery was often used for such patients, but whether exposure or surgery The operation is very difficult, and the tumor needs to be moved repeatedly, which is high risk and difficult.
In view of these unfavorable factors, Prof. Mao Xianhai’s team took a new approach and proposed the application of 3D laparoscopy to complete liver resection.
Considering the deformity of the thoracic and abdominal cavity caused by scoliosis, and the limited space in the abdominal cavity after artificial pneumoperitoneum was established, the expert team designed and planned the surgical position and the positions of the four laparoscopic operating holes after careful analysis.
[Professor Mao Xianhai, Chief Physician Duan Xiaohui, Dr. Chen Botao and others performed laparoscopic right posterior lobe liver tumor resection for the patient]
On March 24, Prof. Mao Xianhai, Chief Physician Duan Xiaohui, Dr. Chen Botao and others performed laparoscopic right posterior lobe liver tumor resection for Mr. Su.
It was found during the operation that, under the influence of scoliosis, the patient’s deformed ribs protruded into the abdominal cavity, and the scoliosis formed a locked “pocket”, which “locked” the right posterior lobe liver tumor in the abdominal cavity. In the “cave” of the right abdominal cavity.
The surgical team made full use of the advantages of laparoscopy, overcame the unfavorable factors of difficult exposure, and successfully removed the tumor.
[Postoperative imaging shows that the liver tumor was completely removed]
The operation took less than 2 hours and the intraoperative blood loss was insufficient 100ml, the tumor was not moved and squeezed during the entire operation.
After the operation, the medical and nursing team of the three departments of hepatobiliary and gallbladder developed a corresponding enhanced recovery surgery strategy for the impact of scoliosis on the patient’s respiratory function. The patient got out of bed and performed respiratory rehabilitation training on the second day after the operation, and was discharged from the hospital on March 29.
[The size of the excised mass is about 6.3×6.5×5cm]
“On the basis of mature laparoscopic hepatobiliary and pancreatic surgery and continuous strengthening of quality control, the team has repeatedly Laparoscopy for hepatobiliary and pancreatic surgery in special patients”.
Director Mao Xianhai said that as early as 2019, he led a team to carry out “Total Inversion Laparoscopic Pancreatoduodenectomy” for patients with total inversion of the organs, and in 2019 the United States Department of Surgery Share with colleagues around the world at the annual meeting.
Chief Physician Duan Xiaohui, deputy director of the Third Department of Hepatobiliary Medicine, reminded that although the incidence of primary liver cancer is high in my country, the public’s understanding of the disease is still insufficient, which makes the diagnosis of primary liver cancer in my country mostly in the early stage. In the middle and late stage, it has become one of the diseases of the hepatobiliary system that threatens the life and health of the people.
“High-risk groups for liver cancer mainly include: hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection, excessive alcohol consumption, nonalcoholic fatty liver diseaseCirrhosis due to other causes, and those with a family history of liver cancer, especially men over 40 years old,” Duan Xiaohui suggested that this group of people should have alpha-fetoprotein and abdominal color ultrasound at least every six months, so that Early detection and early treatment.
(Edited by Rainbow.)
Special author of Hunan Medical Chat: Liang Hui, Wei Chao, Longqian, Hunan Provincial People’s Hospital