目的：探讨绕肝提拉法（LHM）在联合肝脏离断和门静脉切断二步肝切除术（ALPPS）中的应用效果。 方法：回顾性分析4 例原发性肝细胞癌行ALPPS 术患者临床资料，其中肝右叶肿瘤3 例，肝尾状叶肿 瘤1 例，均采用LHM 法导引的一期左、右肝脏原位劈离，右门静脉切断；二期行肿瘤完整切除。 结果：4 例均预先游离肝脏， 成功安置弹力带， 顺利实施二期肝切除术； 一期手术时间195~273 （232.2±35.3）min，术中失血420~1 210（735±344.3）mL，并发胆瘘1 例；二期手术时间98~186 （139.5±36.6）min，术中失血100~320（197.5±95.3）mL；无手术死亡；术后随访3 个月，3 例情 况良好，1 例术后2 个月复发死亡。 结论：LHM 法对于下腔静脉的保护，充分显露左右肝动脉、肝静脉、肝内胆管有较好的效果，可常规 适用于肝肿瘤ALPPS 二步肝切除术。
Application of liver hanging maneuver in associating liver partition and portal vein ligation for staged hepatectomy
Objective: To investigate the efficacy of using liver hanging maneuver (LHM) in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods: The clinical data of 4 patients with primary liver cancer undergoing ALPPS procedure were retrospectively analyzed. Of the patients, 3 cases had tumor in the right lobe and one case in the caudate lobe. All patients underwent first-stage operation of in situ splitting of the liver parenchyma and right portal vein ligation guided by LHM, and a second-stage of complete tumor removal. Results: In all the 4 patients, the prior hepatic transection, hanging tape positioning and second-stage liver resection were performed successfully. In the first-stage operation, the operative time was 195–273 (232.2±35.3) min, intraoperative blood loss was 420–1 210 (735±344.3) mL, and bile leakage occurred in one case; in the secondstage operation, the operative time was 98–186 (139.5±36.6) min, and intraoperative blood loss was 100–320 (197.5±95.3) mL. No operative death occurred. The patients were followed-up for 3 months, at which time 3 patients were in good condition, and one patient had died of recurrence 2 months after operation. Conclusion: LHM is effective for inferior vena cava protection and clear exposure of the intrahepatic blood vessels and ductal system, so it can be routinely used in ALPPS procedure.