探讨手指由上往下分离绕肝提拉法在半肝切除术中的应用价值。

回顾性分析2013年9月至2014年8月在佛山市第一人民医院行半肝切除术的12例患者临床资料。其中男8例，女4例；年龄29～71岁，中位年龄51岁。所有患者均签署知情同意书，符合医学伦理学规定。手术方法为下降肝门板，游离第三肝门，手指由上往下游离第二肝门、肝后隧道，建立绕肝提拉，然后行半肝切除。观察患者手术时间、术中出血量、术后住院时间、并发症发生情况等。

12例患者中11例采用该方法完成手术，建立绕肝提拉过程中均未出现大出血，仅1例需用小指分离，其余均用无名指分离完成。10例行右半肝切除，2例左半肝切除。患者中位手术时间为224（150～320）min，术中出血量550（200～1 000）ml，术后住院时间11（7～18）d。术后出现胆漏1例，腹腔积液1例，胸腔积液1例，均经保守治疗治愈。

手指由上往下分离建立绕肝提拉安全、有效，使复杂的半肝切除手术更安全，可避免损伤大血管和肿瘤破裂。

To investigate the application value of liver hanging maneuver using fingers dissecting from top to down in hemihepatectomy.

Clinical data of 12 patients undergoing hemihepatectomy in the First People's Hospital of Foshan between September 2013 and August 2014 were retrospectively studied. Among the 12 patients, 8 were males and 4 were females with the age ranging from 29 to 71 years old and the median of 51 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. Liver hanging maneuver was established by lowering hilar plate, dissecting the third porta hepatis and dissecting the second porta hepatis and retrohepatic tunnel with fingers from top to down. Then, hemihepatectomy was performed. The duration of operation, intraoperative blood loss, length of hospital stay after surgery and complications were observed.

Eleven of the 12 patients completed the operation with this maneuver. No massive hemorrhage occurred during the establishment of liver hanging. Only 1 patient needed the separation with the small finger and the other patients completed the separation with the third finger. Ten patients underwent right hemihepatectomy and 2 left hemihepatectomy. The median duration of operation was 224 (150-320) min, the intraoperative blood loss was 550(200-1 000) ml and the length of hospital stay after surgery was 11(7-18) d. One patient developed bile leakage, one developed ascites and one developed pleural effusion. All these 3 patients were cured by conservative treatment.

Liver hanging maneuver using fingers dissecting from top to down is safe and effective and makes the complex hemihepatectomy become safer by avoiding the damage to the great vessels and tumor rupture.