How to nurse after right hemihepatectomy?

summary

Right hemihepatectomy is a high-risk and difficult operation with mature laparoscopic hepatectomy and open hepatectomy. The success rate of this operation is not high, and only a few successful cases have been reported abroad. Let's share my experience with you.

How to nurse after right hemihepatectomy?

The right upper rectus abdominis or the right upper paramedian incision is usually used for exploration. When the right hemihepatectomy is decided, it can be extended to the upper right because of the large scope of operation, and the thoracoabdominal incision and diaphragm incision can be performed [Fig. 1 (1)]. When right hemihepatectomy is performed in infants or children, the right upper abdominal incision or subcostal incision can be used instead of thoracotomy. If necessary, the right costal arch cartilage can be cut off.

To separate the right liver, first cut off the ligamentum teres and falciform ligament, gently pull the liver down, and then cut off the right triangular ligament and coronary ligament. When cutting the anterior layer of the right triangular ligament (hepatophrenic ligament), do not damage the bare area of the diaphragm. Then, gently turn the right liver inward and upward, cut the posterior layer of coronary ligament (hepatorenal ligament) close to the liver, and pay attention not to damage the right adrenal gland. Continue to turn the liver upward to expose the inferior vena cava. When separating the right half of the liver, there may be more bleeding. The operation should be careful, and attention should be paid to prevent tearing the short hepatic vein and the right adrenal artery into the inferior vena cava.

To treat the hepatic portal vessel of the first porta hepatis, cholecystectomy should be performed first, and T-shaped tube should be inserted into the remnant of the cystic duct for choledochostomy. When the cystic duct and cystic artery were cut off, the anatomical structure of the first porta hepatis could be clearly displayed. Then, the right hepatic duct and right hepatic artery were separated, ligated and cut off to show the right branch of portal vein. Because the right branch of the portal vein is short, it branches out in the depth of the porta hepatis, and its position is high, so the liver tissue should be carefully separated, and the blood vessels should be ligated and cut off. When the right branch of portal vein is too short and deep, it can be ligated first and not cut off temporarily to avoid accidental injury; After the right hepatic parenchyma was separated and the ligation site of the right portal vein was verified, the right portal vein was cut off and the stump was sutured.

matters needing attention

The falciform ligament and round ligament were fixed in situ to prevent postoperative hepatoptosis. If there is no bleeding or bile leakage, a cigarette or double lumen tube should be placed under the liver section for drainage. If the thoracoabdominal incision is made, a rubber tube should be built in the chest for drainage, and the incision should be sutured.