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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546

Rev. Col. Bras. Cir. vol.27 no.6 Rio de Janeiro Nov./Dec. 2000

http://dx.doi.org/10.1590/S0100-69912000000600010 

ARTIGO DE ATUALIZAÇÃO

 

Utilização das hepatectomias centrais nas cirurgias hepatobiliares

 

Use of central hepatectomies in the hepatobiliary surgeries

 

 

Fábio Luiz Waechter, TCBC-RSI; José Artur SampaioI; Rinaldo Danesi PintoI; Luiz Pereira-Lima, TCBC-RSII

ICirurgiões do Aparelho Digestivo da FFFCMPA
IIProfessor Titular de Cirurgia da FFFCMPA

Endereço para correspondência

 

 


RESUMO

O tratamento das doenças hepatobiliares através de hepatectomias centrais tem sido um dos desafios técnicos mais importantes para a cirurgia neste final de século. Embora diversas técnicas tenham sido utilizadas nas últimas décadas, só recentemente estas têm sido executadas com segurança, diminuindo drasticamente as taxas de morbi-mortalidade, e com isso propiciando resultados favoráveis no tratamento das diferentes afecções hepáticas. Quer o figado apresente-se ou não com hepatopatia crônica, a integração de equipes multidisciplinares afeitas a este tipo de cirurgia e de patologia, permitiu que ressecções complexas fossem realizadas. Com o princípio de manter massa e função hepatocitária remanescente viáveis, o estudo morfológico e funcional do fígado no pré-operatório impõe que técnicas de transplante de segmentos hepáticos sejam freqüentemente utilizadas, seja na reconstrução vascular, seja na redução e conservação de massa hepática. Desta maneira, a ressecção de qualquer parte do fígado com o mínimo de utilização de derivados sangüíneos tem se mostrado factível através do conhecimento apurado da anatomia hepática e da utilização de ecografia transoperatória. Deste trabalho de revisão de diferentes técnicas de hepatectomias centrais são apresentadas, discutidas as indicações e detalhes cirúrgicos de cada uma delas.

Descritores: Hepatectomia; Neoplasia hepática.


ABSTRACT

The treatment of hepatobiliary diseases by central hepatectomies has been one of the most important challenges in surgical technique at the end of this century. Although different techniques were used in the last decades, only recently they have been carried out safely, drastically reducing the morbidity and mortality rates, and thus providing favorable results in treating different hepatic diseases. Whether the liver does or not present chronic liver disease, the integration of related multiple-disciplinary teams in this type of surgery and disease has allowed complex ablations, sometimes bordering on the limit of the possibility of life.Based on the principle of maintaining a viable remaining hepatocyte mass and function, the morphological and functional study of the liver during the preoperative period requires the frequent use of techniques to transplant liver segments, both for vascular reconstruction and for the reduction and conservation of the liver mass. Thus, the resection of any part of the liver with a minimum use of blood products has proved feasible with thorough knowledge of the anatomy of the liver, and the use of echography during surgery. Different central hepatectomy techniques are, thus, presented, discussing indications and surgical details of each of them.

Key words: Hepatectomy; Hepatic neoplasm.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para correspondência:
Dr. Fábio Luiz Waechter
Rua Barros Cassal 475/802
90035-030 - Porto Alegre - RS
Fax: (51) 311 3310
E-mail: waechter@zaz.com.br

Recebido em 13/9/1999
Aceito para publicação em13/6/2000

 

 

Trabalho realizado no Serviço de Cirurgia do Complexo Hospitalar Santa Casa e Fundação Faculdade Federal de Ciências Médicas de Porto Alegre – FFFCMPA.

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