Utilização das hepatectomias centrais nas cirurgias hepatobiliares

Use of central hepatectomies in the hepatobiliary surgeries

ARTIGO DE ATUALIZAÇÃO

Utilização das hepatectomias centrais nas cirurgias hepatobiliares

Use of central hepatectomies in the hepatobiliary surgeries

Fábio Luiz Waechter, TCBC-RS^I; José Artur Sampaio^I; Rinaldo Danesi Pinto^I; Luiz Pereira-Lima, TCBC-RS^II

^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.

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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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Datas de Publicação

• Publicação nesta coleção
  18 Dez 2008
• Data do Fascículo
  Dez 2000

Histórico

• Aceito
  13 Jun 2000
• Recebido
  13 Set 1999