切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (02) : 261 -265. doi: 10.3877/cma.j.issn.2095-3232.2026.02.018

综述

精准肝切除术技术进展与临床应用
杨春元1, 邓旭1,2, 王晶晶2, 阳丹才让2, 潘伟1,()   
  1. 1 641500 四川省资阳市,乐至县人民医院肝胆胰外科
    2 810000 西宁,青海大学附属医院肝胆胰外科
  • 收稿日期:2025-08-28 出版日期:2026-04-10
  • 通信作者: 潘伟
  • 基金资助:
    青海省科技计划项目(创新平台建设专项)(2020-ZL-Y01)

Technical progress and clinical application of precise hepatectomy

Chunyuan Yang1, Xu Deng1,2, Jingjing Wang2, Cairang Yangdan2, Wei Pan1,()   

  1. 1 Department of Hepatobiliary and Pancreatic Surgery, the People's Hospital of Lezhi, Ziyang 641500, China
    2 Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining 810000, China
  • Received:2025-08-28 Published:2026-04-10
  • Corresponding author: Wei Pan
引用本文:

杨春元, 邓旭, 王晶晶, 阳丹才让, 潘伟. 精准肝切除术技术进展与临床应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 261-265.

Chunyuan Yang, Xu Deng, Jingjing Wang, Cairang Yangdan, Wei Pan. Technical progress and clinical application of precise hepatectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 261-265.

精准肝切除术是近年来肝脏外科的重要进展,其通过精确的术前评估、个体化手术规划和术中精确切除,实现最小的手术创伤和最佳的肝脏保护。三维重建和3D打印技术在术前为外科医师提供了肝脏及其脉管系统的直观呈现,帮助制定个体化手术方案并减少并发症。多模态分子影像技术及人工智能的应用进一步提高了术中监测和导航的精度,尤其是荧光成像技术可精确识别肿瘤边界并引导切除范围。此外,通过采用低中心静脉压及每搏量变异度监测等麻醉管理策略,有效提高了手术安全性及患者术后预后。尽管该技术面临成本高昂及技术复杂等挑战,但随着医学影像和人工智能技术的不断发展,精准肝切除术有望在临床实践中得到更广泛的应用。

Precise hepatectomy is an important progress in liver surgery in recent years. Through precise preoperative evaluation, individualized surgical planning and accurate intraoperative resection, it can achieve minimal surgical trauma and optimal liver protection. Three-dimensional (3D) reconstruction and 3D printing technology provide surgeons with intuitive presentation of the liver and its vascular system before operation, which helps to formulate individualized surgical plans and reduce the risk of complications. The application of multi-modal molecular imaging technology and artificial intelligence further improves the precision of intraoperative monitoring and navigation, especially the fluorescence imaging technology can accurately identify the tumor margin and guide the range of resection. In addition, surgical safety and postoperative prognosis of patients can be effectively improved by adopting anesthesia management strategies such as low central venous pressure and monitoring stroke volume variability. Although this technology faces multiple challenges such as high cost and complex technology, precise hepatectomy is expected to be more widely applied in clinical practice along with persistent development of medical imaging and artificial intelligence technologies.

[1]
Wei XB, Xu J, Li N, et al. The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. HPB, 2016, 18(3): 287-295.DOI: 10.1016/j.hpb.2015.10.007.
[2]
董家鸿, 黄志强. 精准肝切除——21世纪肝脏外科新理念[J]. 中华外科杂志, 2009, 47(21): 1601-1605.DOI: 10.3760/cma.j.issn.0529-5815.2009.21.001.
[3]
Ni ZK, Lin D, Wang ZQ, et al. Precision liver resection: three-dimensional reconstruction combined with fluorescence laparoscopic imaging[J]. Surg Innov, 2021, 28(1): 71-78.DOI: 10.1177/1553350620954581.
[4]
中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会临床精准医学专业委员会, 等. 复杂性肝脏肿瘤三维可视化精准诊治指南(2019版)[J]. 中国实用外科杂志, 2019, 39(8): 766-774.DOI: 10.19538/j.cjps.issn1005-2208.2019.08.02.
[5]
Chen H, He Y, Jia W. Precise hepatectomy in the intelligent digital era[J]. Int J Biol Sci, 2020, 16(3): 365-373.DOI: 10.7150/ijbs.39387.
[6]
范应方, 蔡伟, 方驰华. 肝脏分段解剖及其研究进展[J]. 中国实用外科杂志, 2014, 34(11): 1105-1108 .DOI: 10.7504/CJPS.ISSN1005-2208.2014.11.33.
[7]
Yao WF, Huang XK, Fu TW, et al. Precise planning based on 3D-printed dry-laboratory models can reduce perioperative complications of laparoscopic surgery for complex hepatobiliary diseases: a preoperative cohort study[J]. BMC Surg, 2024, 24(1): 148.DOI: 10.1186/s12893-024-02441-z.
[8]
徐安书, 傅朝春, 韦萍, 等. 3D打印技术在精准切除治疗肝脏肿瘤中的应用[J]. 中国普通外科杂志, 2018, 27(1): 29-34.DOI: 10.3978/j.issn.1005-6947.2018.01.005.
[9]
刘珂, 薄开蕊, 刘琳, 等. 影像技术在“精准肝切除”术中导航的应用[J]. 中国临床解剖学杂志, 2018, 36(4): 474-476.DOI: 10.13418/j.issn.1001-165x.2018.04.027.
[10]
张蕊娟, 范龙飞, 周家宇, 等. 多模态分子探针的研究进展[J]. 中国血液流变学杂志, 2022, 32(1): 161-166.DOI: 10.3969/j.issn.1009-881X.2022.01.036.
[11]
周晖, 吴俊娇, 范洁琳, 等. 多模态分子影像技术应用于肿瘤的研究进展[J]. 中国医学影像学杂志, 2011, 19(10): 794-797.DOI: 10.3969/j.issn.1005-5185.2011.10.022.
[12]
Lambin P, Rios-Velazquez E, Leijenaar R, et al. Radiomics: extracting more information from medical images using advanced feature analysis[J]. Eur J Cancer, 2012, 48(4): 441-446.DOI: 10.1016/j.ejca.2011.11.036.
[13]
Vu TH, Mousavi HS, Monga V, et al. Histopathological image classification using discriminative feature-oriented dictionary learning[J]. IEEE Trans Med Imaging, 2016, 35(3): 738-751.DOI: 10.1109/TMI.2015.2493530.
[14]
Ye JJ. Artificial intelligence for pathologists is not near—it is here: description of a prototype that can transform how we practice pathology tomorrow[J]. Arch Pathol Lab Med, 2015, 139(7): 929-935.DOI: 10.5858/arpa.2014-0478-oa.
[15]
Wang L, Song D, Wang W, et al. Data-driven assisted decision making for surgical procedure of hepatocellular carcinoma resection and prognostic prediction: development and validation of machine learning models[J]. Cancers, 2023, 15(6): 1784.DOI: 10.3390/cancers15061784.
[16]
Tashiro Y, Aoki T, Kobayashi N, et al. Color-coded laparoscopic liver resection using artificial intelligence: a preliminary study[J]. J Hepatobiliary Pancreat Sci, 2024, 31(2): 67-68.DOI: 10.1002/jhbp.1388.
[17]
Biancofiore G, Critchley LAH, Lee A, et al. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery[J]. Br J Anaesth, 2009, 102(1): 47-54.DOI: 10.1093/bja/aen343.
[18]
Kusminsky RE. Complications of central venous catheterization[J]. J Am Coll Surg, 2007, 204(4): 681-696.DOI: 10.1016/j.jamcollsurg.2007.01.039.
[19]
Dunki-Jacobs EM, Philips P, Scoggins CR, et al. Stroke volume variation in hepatic resection: a replacement for standard central venous pressure monitoring[J]. Ann Surg Oncol, 2014, 21(2): 473-478.DOI: 10.1245/s10434-013-3323-9.
[20]
Peng K, Li J, Cheng H, et al. Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery[J]. Med Princ Pract, 2014, 23(5): 413-420.DOI: 10.1159/000363573.
[21]
Xu H, Shu SH, Wang D, et al. Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial[J]. J Thorac Dis, 2017, 9(9): 2992-3004.DOI: 10.21037/jtd.2017.08.98.
[22]
Su BC, Tsai YF, Cheng CW, et al. Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation[J]. Transplant Proc, 2012, 44(2): 429-432.DOI: 10.1016/j.transproceed.2011.12.037.
[23]
梅习平, 刘际童, 王亚平, 等. 以每搏量变异度为指导的液体治疗在腹腔镜精准肝切除术中的应用[J]. 中南大学学报(医学版), 2019, 44(10): 1163-1168.DOI: 10.11817/j.issn.1672-7347.2019.190121.
[24]
Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study[J]. Crit Care, 2010, 14(3): R118.DOI: 10.1186/cc9070.
[25]
Giustiniano E, Procopio F, Ruggieri N, et al. Impact of the FloTrac/VigileoTM monitoring on intraoperative fluid management and outcome after liver resection[J]. Dig Surg, 2018, 35(5): 435-441.DOI: 10.1159/000481406.
[26]
Lim C, Vibert E, Azoulay D, et al. Indocyanine green fluorescence imaging in the surgical management of liver cancers: current facts and future implications[J]. J Visc Surg, 2014, 151(2): 117-124.DOI: 10.1016/j.jviscsurg.2013.11.003.
[27]
Ishizawa T, Masuda K, Urano Y, et al. Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma[J]. Ann Surg Oncol, 2014, 21(2): 440-448.DOI: 10.1245/s10434-013-3360-4.
[28]
Tangsirapat V, Kengsakul M, Udomkarnjananun S, et al. Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis[J]. BMC Surg, 2024, 24(1): 181.DOI: 10.1186/s12893-024-02469-1.
[29]
Shimada S, Ohtsubo S, Ogasawara K, et al. Macro-and microscopic findings of ICG fluorescence in liver tumors[J]. World J Surg Oncol, 2015, 13: 198.DOI: 10.1186/s12957-015-0615-5.
[30]
Lim JSH, Shelat VG. 3D laparoscopy and fluorescence imaging can improve surgical precision for hepatectomy[J]. Hepatobiliary Surg Nutr, 2024, 13(3): 544-547.DOI: 10.21037/hbsn-23-223.
[31]
中华医学会数字医学分会, 中国研究型医院学会数字智能化外科专业委员会, 中国医师协会肝癌专业委员会. 中央型肝癌三维可视化精准诊疗中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(4): 361-368.DOI: 10.19538/j.cjps.issn1005-2208.2020.04.01.
[32]
Tian F, Cao L, Chen J, et al. 3D laparoscopic anatomical hepatectomy guided by 2D real-time indocyanine green fluorescence imaging for hepatocellular carcinoma[J]. Hepatobiliary Surg Nutr, 2024, 13(3): 494-499.DOI: 10.21037/hbsn-22-587.
[33]
彭子洋, 王志博, 巴赫, 等. 增强现实、虚拟现实与混合现实在腔镜肝脏外科中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(1): 13-17.DOI: 10.3877/cma.j.issn.2095-3232.2025005.
[1] 王祝愉, 权晶晶. 人工智能辅助参与牙体牙髓基础与临床研究[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(01): 25-33.
[2] 吕思怡, 王琰琪, 仇珺, 陈宇江, 高洁. 人工智能图像处理技术在口腔医学中的应用[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(01): 40-46.
[3] 李翠君, 蔡耿彬, 梁晓铟, 王泳怡, 詹欣怡, 古佩明. 人工智能在口腔护理中的应用[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(01): 47-50.
[4] 陈泽涛, 邱龙诗语, 龚卓弘, 刘恒毅, 曾培生, 施梦汝. 口腔种植定量测量人工智能化的难点解析与解决策略[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(01): 1-8.
[5] 杨婷麟, 黄韬. 人工智能应用于甲状腺结节评估的进展与挑战[J/OL]. 中华普通外科学文献(电子版), 2026, 20(01): 60-65.
[6] 徐竟益, 孙凯, 王爽, 吴柳盛, 梁悦华, 杨宇帆, 赵雨桐, 杨雷, 王文强, 闫军. 吲哚菁绿在肝胆胰外科中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 91-95.
[7] 牛晓华, 黄长文. 腹腔镜肝切除平面探讨:多技术融合肝切除平面定位策略理论与实践[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 167-171.
[8] 邓玉飞, 王志鑫, 娄珂, 张林轩, 马桂春, 港措. 影像组学在肝癌精准诊断、疗效评估及治疗方案决策优化中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 172-180.
[9] 东小鸽, 樊海宁, 侯立朝, 杜凯豪, 刘海刚, 汪占金, 薛伟伟, 石亚超, 魏六木, 王展. 三维可视化技术、ICG荧光示踪和术中实时超声在肝癌个性化精准诊疗中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 181-189.
[10] 郑述昊, 李威威, 袁文康, 张超, 张冲. ICG荧光影像在肝脏肿瘤解剖性肝切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 257-260.
[11] 唐玥, 陈家璐, 覃德龙, 李宗龙, 汤朝晖, 全志伟. 基于AI的多模态影像在肝癌诊治中应用及面临挑战[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 4-9.
[12] 杨宇尘, 陈拥军. 三维可视化技术在肝癌转化治疗辅助决策中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 10-15.
[13] 刘郁芳, 赵青. 直肠癌MRI影像学评估:从精准分期到预后预测的研究进展与展望[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 31-36.
[14] 陈小坤, 杜顺达. 影像组学在肝细胞癌中的应用进展及挑战[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 97-100.
[15] 杜昊楠, 张广健, 王嘉巍, 梁挺, 锁瑞洋, 张佳. 人工智能在肺结节诊疗体系中的应用前景[J/OL]. 中华胸部外科电子杂志, 2026, 13(01): 64-73.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?