腹腔镜活体供肝切取术:回顾与展望

Living donor hepatectomy: review and prospects

随着腹腔镜微创技术的不断普及,腹腔镜肝切除在肝脏良恶性疾病的治疗中已逐渐成为主流。全腔镜下活体供肝切取是最具吸引力也最具争议的应用之一,供者安全和受者移植后疗效是争议的主要焦点。自2002年首例全腹腔镜供肝切取报道以来,目前在部分移植中心,腹腔镜活体供肝切取已得到广泛应用。从早期的左肝、左外移植物到更复杂的右半肝移植物,从作为过渡形式的手辅助腹腔镜供肝切取到全腹腔镜供肝切取,目前全腹腔镜供肝切取已日臻成熟。笔者对腹腔镜供肝切取的发展历史进行了回顾,并基于个人经验对其技术细节进行了简要分析。

With the popularization of the minimally invasive laparoscopic techniques, laparoscopic hepatectomy has increasingly become the mainstay for the treatment of both benign and malignant liver diseases. Living donor hepatectomy is one of its most attention-drawing and controversial practical uses. From the first pure laparoscopic donor hepatectomy reported in 2002, pure laparoscopic living donor hepatectomy has been frequently used in some experienced transplant centers. Evolving from the early left/left lateral segment grafts to the more complex right liver graft, and from the hand-assisted to pure laparoscopic approach, laparoscopic living donor hepatectomy is now much more mature. Here, the authors review the development history of laparoscopic living donor hepatectomy, and also analyze its technical details based on personal experiences.