Japanese Journal of Acute Care Surgery 2013; 3: 61~69 原著 重症肝外傷に対するダメージコントロール手術としてのグリソン一括処理法の応用 小泉哲佐治攻片山真史岸真也小林慎二郎中野浩平泰彦大坪毅人 所属 : 聖マリアンナ医科大学消化器 一般外科住所 : 216-8511 神奈川県川崎市宮前区菅生 2-16-1
Fig.1 Fig. 1 Segmentation of the of the liver liver with with respect to to the tree of the Glissonean pedicle 7) 7) A / B Anterior Segment Left lobe Caudate lobe Posterior Segment Fig. 1-A Anterior, Posterior segments, and left lobe are nourished respectively by each secondary branch. The caudate lobe is nourished directly by the primary branch. Fig. 1-B Three components (artery, vein, and bile duct) wrapped with connective tissue and anatomically the same structure, extend into the liver. Fig.2 Fig. Glissonean 2 Glissonean pedicle pedicle transection method at at the the hepatic hilus A B Fig. 2-A Detaching and taping of the right anterior glissonean pedicle using forceps. Fig. 2-B This is the subtraction method for the taping of the right posterior glissonean pedicle. The right main pedicle is taped. The right posterior glissonean pedicle can be taped following the right main pedicle.
Fig. 3 Fig.3 A CB CB D Fig. 3-A (Case 1) State immediatery after crash laparotomy. A large amount of blood has accumulated in the abdominal cavity. Fig. 3-B, C, D (Case 1) Three parts of the large type IIIb injury can be seen in the right lobe of the liver. Fig.4 Fig. 4 Fig. 4 (Case 1) CT scan post damage control surgery. Right lobe of the liver has fallen to ischemic state completely.
Fig.5 5 A CB CB D Fig. 5 (Case 1) The scene of right hepatectomy as definitive operation. Fig.6 6 Fig. 6 (Case 1) Resected specimen of right hepatectomy.
Fig.7 7 Fig. 7 (Case 2) CT performed as the first step of secondary survey. A large type IIIb injury in the right lobe of the liver can be seen. Fig.8 Fig. 8 A / B Fig. 8 After Glissonean pedicle ligation of the right lobe of the liver as damage control surgery, right hepatectomy was performed.
Glissonean Pedicle Ligation Method as the Optional Technique of Damage Control Surgery for Severe Liver Trauma Satoshi Koizumi 1), Osamu Saji 1), Masafumi Katayama 1), Shinya Kishi 1), Shinjirou Kobayashi 1), Hiroshi Nakano 1), Yasuhiko Taira 2), Takehito Otsubo 1) Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine Department of Emergency and Critical Care Medicine, St. St. Marianna University School of Medicine Introduction Treatment strategy for severe liver trauma is peri-hepatic gauze packing as a damage control surgery and vascular embolization after surgery. However, we sometimes encounter cases that cannot be adequately treated with only this strategy. So we introduce a new optional treatment strategy for severe liver trauma or Glissonean pedicle ligation method. Method The Glissonean pedicle consists of three kinds of vessels: portal vein, hepatic artery, and bile duct. Given Glissonean pedicle unit, the liver can be separated into three segments. And we can taping processed separately anterior and posterior segmental branch extra hepatic portion. By ligating the segmental Glissonean pedicle of damaged area, stop bleeding completely. After improving the general condition, we will perform hepatectomy of the segment of Glissonean pedicle was ligated as a definitive operation. Waitable time is 12 hours. Results In the past, we performed right hepatectomy as a definitive operation, after ligation of the anterior and posterior segmental Glissonean pedicle as a damage control surgery, twice. Both patients has gotten a good course. Discussion Although there is a problem that it takes many time to learn the procedure, Glissonean pedicle ligation method is useful as an option of damage control surgery. Key words :Liver traurma, Damage control surgery, Glissonean pedicle transection method