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近年来,我们采用腹腔镜经脐静脉行门静脉置管术治疗晚期不能切除的原发性肝癌,取得良好近期效果.现介绍操作和体会如下.操作方法 病人气管内插管全麻后,取仰卧位,于脐上缘刺入气腹针,充CO_2气体制造气腹,至腹内压达1.85kPa后.于脐上缘切开10mm的皮肤切口,刺入10mm穿刺器套管作为观察孔,置入腹腔镜观察.在腹腔镜直视下,分别于剑突下偏左、右肋下锁骨中线、右腋前线刺入10mm、5mm、5mm穿刺器套管作为主、辅操作孔,置入腹腔镜手术器械.在腹腔镜指引下,电钩分离切断肝镰状韧带,使肝圆韧带游离;贴近腹壁切断肝圆韧带,将肝圆韧带近肝断端自剑突下穿刺孔拖出腹腔外.撤除气腹.在肝圆韧带内找到闭塞的脐静脉,用3号胆道探子探通脐静脉,可见血液溢出,此时立即将全植入式门静脉药物灌注装置的导管经脐静脉插入门静脉内,固定.经药盒注入无菌美蓝,见肝脏染色,而无美蓝流入腹腔,即将肝圆韧带送回腹腔内,药盒埋于主操作孔下方皮下,缝合伤口.
In recent years, we have used laparoscopic umbilical vein portal vein catheterization for the treatment of advanced unresectable primary liver cancer, and achieved good short-term results. Now we introduce the operation and experience as follows. Operation method Patient tracheal intubation after general anesthesia, take supine Position the pneumoperitoneum needle on the upper edge of the umbilicus and inflate the pneumoperitoneum with CO 2 gas until the intra-abdominal pressure reaches 1.85 kPa. Cut the 10mm skin incision on the umbilicus and insert a 10mm puncture cannula as the observation hole. Laparoscopy was performed. Under laparoscopic visualization, 10mm, 5mm, and 5mm trocar sleeves were inserted as the main and auxiliary operating holes under the xiphoid left and right subcostal midline and right anterior line respectively. Laparoscopic surgical instruments. Under the guidance of laparoscope, the electric hook separates and cuts the hepatic falciform ligament and frees the round ligament of the hepatic stenosis; closes the round ligament of the hepatic wall close to the abdominal wall, and pulls the proximal hepatic stenosis of the hepatic ligament from the xiphoid puncture hole out of the abdominal cavity. In addition, the pneumoperitoneum is removed. The occluded umbilical vein is found in the round ligament of the liver and the umbilical vein is probed with a bile duct probe No. 3, which shows that the blood overflows. At this time, the catheter of the fully implanted portal vein drug infusion device is immediately inserted into the portal vein through the umbilical vein. Inside, fixed. Injected into the sterile melbourne through the kit, see liver dyed Color, but no beauty blue flows into the abdominal cavity, that is, the round ligament of the liver is sent back to the abdominal cavity, and the medicine box is buried under the main operation hole under the skin, and the wound is sutured.