腹腔镜解剖性肝切除的利与弊

The advantages and disadvantages of laparoscopic anatomic hepatectomy

腹腔镜肝切除已被广泛应用于各种肝脏良恶性疾病的治疗和活体供肝的切取,其优势日益受到认可。腹腔镜解剖性肝切除与非解剖性肝切除的区别在于前者预先解剖和阻断预切除肝脏的入肝和(或)出肝血流,从而使得控制出血效果更优,断肝更加安全,可降低术中出血和气体栓塞风险、减少术后并发症,还可以降低肝癌术后复发率,可望提高肝癌的疗效;但也存在学习曲线长、肝切缘定位困难等弊端。腹腔镜肝切除时究竟选择解剖性切除还是非解剖性切除目前尚存争议。本文结合国内外文献就腹腔镜解剖性肝切除的利弊做一综述。

Laparoscopic hepatectomy has been widely performed in the treatment of various benign and malignant liver diseases and even for the harvest of living donor liver, its advantages are increasingly accepted . The difference between the laparoscopic anatomic and non-anatomic hepatectomy is that the former previously dissected and blocked the inflow and/or outflow of the pre-cutting liver, which allows more effective control of bleeding and is more safer for the liver resection. It is also associated with reduced risk of intraoperative bleeding and gas embolism, with less postoperative complications and lower postoperative recurrence rate. Laparoscopic anatomic hepatectomy is expected to improve the curative effect of liver cancer , but there are also drawbacks such as long learning curve and difficulties in locating hepatic cutting edge. Whether to choose anatomic resection or non-anatomic resection in laparoscopic hepatectomy remain controversial. This paper reviewed the advantages and disadvantages of laparoscopic anatomic hepatectomy by consulting of domestic and foreign literatures.