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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 267 -271. doi: 10.3877/cma.j.issn.2095-3232.2023.03.004

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腹腔镜肝脏手术中一些值得深入思考的问题
黄洁1,()   
  1. 1. 650102 昆明医科大学第二附属医院肝胆胰外科
  • 收稿日期:2023-02-07 出版日期:2023-06-10
  • 通信作者: 黄洁
  • 基金资助:
    云南省科技厅基础研究专项-面上项目(202101AT070239); 云南省科技厅昆医联合项目-面上项目(202001AY070001-229)

Concerns on laparoscopic liver surgery

Jie Huang1()   

  • Received:2023-02-07 Published:2023-06-10
  • Corresponding author: Jie Huang
引用本文:

黄洁. 腹腔镜肝脏手术中一些值得深入思考的问题[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 267-271.

Jie Huang. Concerns on laparoscopic liver surgery[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(03): 267-271.

自1991年Reich等[1]率先报道了腹腔镜肝切除术(laparoscopic hepatectomy,LH)以来,LH技术突飞猛进。然而,与其他专业相比,其推广速度和创新突破仍较为缓慢,主要原因为肝脏实质离断和肝门解剖技术复杂、术中大出血风险高以及肝脏恶性肿瘤切缘和肝硬化患者肝切除量"安全界限"的平衡。越来越多文献显示,微创肝脏手术是治疗原发性和继发性肝脏疾病的可行选择[2]。在肝细胞癌(肝癌)治疗策略中,2008年在美国Louisville和2014年在日本Morioka分别召开的第一届和第二届国际腹腔镜肝切除共识研讨会,颁布了相关共识及指南,LH在肝癌治疗中的价值已得到世界范围的认可[3,4]。2017年Southampton共识进一步拓展了LH治疗肝癌的适应证,包括需行ALPPS的复杂肝癌、大肝癌和血管受侵的肝癌等[5]。2017年亚太共识对LH治疗肝癌中一些有争议的关键问题提出了相应的推荐建议[6]。然而,在肝癌患者中普遍采用LH仍存在一些局限性:首先,微创肝脏外科医师必须有足够的能力应对腹腔镜和开腹肝脏手术。其次,LH的流程仍需考虑到肝肿瘤的病理学特性以及在腹腔镜特殊环境下对肿瘤细胞微小转移的影响[7,8]。最后,肿瘤的位置、大小、肿瘤与重要血管的关系和肝功能代偿的相关问题仍需进一步研究讨论。本文就以上这些问题进行简要探讨,以期为今后开展LH提供思路。

图1 腹腔镜肝脏手术手绘手术设计图注:a为肝左叶离断手术设计图;b为肝门部胆管癌手术设计图
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