Abstract: Objective To introduce how to identify intrahepatic anatomical structure by laparoscopic ultrasound （LUS）. Methods In one case of laparoscopic hepatectomy, using LUS to complete liver map scanning through different Trocars was performed and its imaging was collected. Results Several standard imaging of intrahepatic anatomical structure were obtained by axial rotation scanning of LUS： ①Right hepatic pedicle, right hepatic vein and middle hepatic vein were scanned by LUS through a subxiphoid Trocar. The right hepatic pedicle branched out into AT and PP, and then branched out into P5, P8 and P6, P7; V5d, V6, V8d and AFV flowed into the right hepatic vein successively, while V4, V5v and V8v flowed into the middle hepatic vein. ②Left hepatic pedicle, left hepatic vein, and middle hepatic vein were scanned by LUS through a trocar under the right costal margin. The left hepatic pedicle branched out into P2, P3, P4, V2, V3 flowed into left hepatic vein, and inferior vena cava and the vertical axis of middle hepatic vein were also scanned from this way. Conclusion The “standard imaging” of LUS in liver scaning is very helpful to identify the intrahepatic anatomical structure correctly. Surgeons must master the essential technique of LUS in liver scaning, which needs in-depth study and repetition training. After that, LUS would play a guiding role in laparoscopic hepatectomy.

Key words: laparoscopic ultrasound, laparoscopic hepatectomy, intraoperative ultrasound

摘要： 目的 介绍腹腔镜超声（LUS）肝内管道结构的辨识。方法 通过一例腹腔镜肝切除术,经不同Trocar进入LUS行肝脏扫查并采集图像。结果 LUS探头通过轴向旋转扫查肝脏获得几个标准切面：①通过剑突下Trocar扫查右肝蒂及肝右静脉、肝中静脉,分别追踪右肝蒂分为AT、PP,再分为P5、P8与P6、P7;V5d、V6、V8d、AFV相继汇入肝右静脉,V4、V5v、V8v则汇入肝中静脉;②通过右侧肋缘下Trocar扫查左肝蒂及肝左静脉、肝中静脉,分别追踪左肝蒂分为P2、P3、P4以及V2、V3汇入肝左静脉,进一步扫查肝中静脉长轴、下腔静脉。结论 LUS肝脏扫查的“标准切面”有助于肝内管道结构的正确辨识。外科医生必须自己掌握LUS扫查肝脏的基本功,通过深入学习并反复练习,才能真正发挥LUS在腹腔镜肝切除术中的引导作用。

关键词: 腹腔镜超声, 腹腔镜肝切除, 术中超声