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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (02) : 145 -157. doi: 10.3877/cma.j.issn.2095-3232.2025023

指南与共识

精准制导技术应用于肝脏肿瘤诊断与治疗中国专家共识(2024 版)
中华预防医学会肝胆胰疾病预防与控制专业委员会, 中国医疗保健国际交流促进会肝脏肿瘤学分会   
  • 收稿日期:2024-03-25 出版日期:2025-04-10
  • 基金资助:
    国家自然科学基金(82272963)北京市自然科学基金(4222058)中国科学科学院科技创新基金(2021-I2M-1-066)

Chinese expert consensus on precision guidance technology in diagnosis and treatment of liver tumors(2024 edition)

and Pancreatic Disease Prevention and Control Specialty Society of Chinese Prevention Medicine Association Hepatobiliary, Branch of China International Exchange and Promotive Association for Medical and Healthcare Hepato-Oncology   

  • Received:2024-03-25 Published:2025-04-10
引用本文:

中华预防医学会肝胆胰疾病预防与控制专业委员会, 中国医疗保健国际交流促进会肝脏肿瘤学分会. 精准制导技术应用于肝脏肿瘤诊断与治疗中国专家共识(2024 版)[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 145-157.

and Pancreatic Disease Prevention and Control Specialty Society of Chinese Prevention Medicine Association Hepatobiliary, Branch of China International Exchange and Promotive Association for Medical and Healthcare Hepato-Oncology. Chinese expert consensus on precision guidance technology in diagnosis and treatment of liver tumors(2024 edition)[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 145-157.

大多数肝脏恶性肿瘤患者初诊时已处于中晚期,预后不佳。早期诊断和治疗是改善肝脏恶性肿瘤疗效的关键。近年随着治疗方法和理念的不断发展和进步,肝脏恶性肿瘤的预后得到极大改善,目前外科手术切除仍是肝脏恶性肿瘤治疗的首选方式。精准肝切除是达到最佳手术效果的技术保障,而术前精准评估、术中实时定位病灶和实时引导切除仍是精准肝切除的重中之重。为提高肝脏恶性肿瘤术前诊断、术中精准切除和术后疗效,中华预防医学会肝胆胰疾病预防与控制专业委员会及中国医疗保健国际交流促进会肝脏肿瘤学分会组织行业领域专家,围绕肝脏肿瘤精准定位和导航的相关要点开展深入讨论并形成《精准制导技术应用于肝脏肿瘤诊断与治疗中国专家共识(2024 版)》,以期指导临床实践,推动学科发展。

Most patients with liver malignant tumors are diagnosed as in the middle or advanced stages when first diagnosed, while the prognosis is quite poor in these stages.Early diagnosis and treatment are the key to improve the curative effect of liver malignant tumors.Recently, with the sustainable development and progress of the treatment method, the prognosis of liver malignant tumors has been greatly improved.The surgical resection is still the first-choice in the treatment of liver malignant tumors.Precise hepatectomy is the guarantee to achieve the best surgical results, while precise preoperative assessment,intraoperative real-time lesion localization and real-time guidance are the priority to the precise hepatectomy.In order to improve the preoperative diagnosis, precise intraoperative resection and postoperative curative effect of liver malignant tumors, the Hepatobiliary and Pancreatic Disease Prevention and Control Specialty Society of Chinees Prevention Medicine Association and the Hepato-Oncology Branch of China International Exchange and Promotive Association for Medical and Healthcare organize experts to conduct in-depth discussion on the key points of precise localization and navigation of liver tumors and formulated the Chinese expert consensus on precision guidance technology in diagnosis and treatment of liver tumors (2024 edition),which could guide the clinical practice and promote the development of the subject.

表1 证据等级
表2 推荐意见级别
表3 全氟丁烷微球术中超声造影检查发现新病灶和鉴别诊断的研究a
作者 发表年份 研究类型 诊断 病例数(例) 术前发现病灶
长径(cm) 数量(个)
Uchiyama等[58] 2010年 前瞻性研究 结直肠癌肝转移 22 2.2(0.6~5.8) -
Nanashima等[39] 2011年 - 肝细胞癌 25 3.4±1.9 -
结直肠癌肝转移 20
其他 5
Arita等[61] 2011年 前瞻性研究 肝细胞癌 192 1.6(0.2~20) -
Takahashi等[59] 2012年 前瞻性研究 结直肠癌肝转移 102 - -
Mitsunori等[60] 2013年 前瞻性研究 肝细胞癌 52 3(0.5~14) -
Abo等[67] 2015年 前瞻性研究 肝细胞癌 56 - -
结直肠癌肝转移 36
其他 25
Arita等[62] 2015年 前瞻性研究 结直肠癌肝转移 100 - -
Li等[66]b 2021年 前瞻性研究 转移性肝癌 27 - -
王子承等[64] 2022年 - 转移性肝癌 28 - 36
段文斌等[63] 2022年 - 肝细胞癌 49 2.07±0.51 56
作者 术中新发病灶 新发恶性病灶/恶性病灶总数(%) 诊断效能(%)
总数(个) 恶性病灶(个) 恶性病灶长径(cm) 灵敏度 特异度 阳性预测值 阴性预测值 准确度
Uchiyama等[58] 3 3 0.7(0.4~1.1) 3.8 98.1 - 96.3 - 94.4
Nanashima等[39] 3 1个肝细胞癌 0.8 16.7 - - - - -
2个结直肠癌肝转移 0.3和0.5
Arita等[61] 79 17 0.65(0.2~2.0) 4.6 65.0 94.0 - - 97.0
Takahashi等[59] 19 19 - 4.9 97.1 59.1 95.4 70.3 93.2
Mitsunori等[60] 10 8 0.7(0.4~1.3) 9.4 97.6 - 91.2 - -
Abo等[67] - - - - 98.0 83.0 99.0 71.0 97.0
Arita等[62] 22 17 0.5(0.2~1.0) 7.1 99.0 - 98.0 - 97.0
Li等[66]b - 8 0.4~0.9 9.8 97.5 94.1 98.8 88.9 97.0
王子承等[64] 3 均为结直肠癌肝转移 - 7.7 - - - - -
段文斌等[63] 3 3 - 5.4 - - - - -
表4 全氟丁烷微球术中超声造影检查对术前方案的影响
表5 全氟丁烷微球术中超声造影检查发现新辅助治疗后消失的结直肠癌肝转移病灶
图1 吲哚菁绿正染法和反染法示意图 注:a 为吲哚菁绿正染法;b 为吲哚菁绿反染法
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