腹腔镜技术在肝内胆管癌手术中应用

Application of laparoscopy in operation of intrahepatic cholangiocarcinoma

外科手术是目前肝内胆管癌(ICC)的主要治疗方法,在肿瘤多学科综合治疗新时代下,其作用将发生变化。ICC侵袭转移能力强,主要沿Glisson鞘转移和淋巴转移,基于门静脉流域的解剖性肝切除更具肿瘤学意义。随着腔镜可视化技术的发展,腹腔镜解剖性肝切除及区域淋巴结清扫可能更具技术优势。初步研究表明,腹腔镜下ICC根治术相较于开放手术拥有更好的围手术期疗效和可能相媲美的肿瘤学疗效,同时还须积累更多病例及随机对照研究以进一步评价这一技术的微创性和有效性。严格选择适应证,成熟的腹腔镜肝脏外科技术储备和优良的手术装备,同质化的肿瘤学外科原则是安全探索腹腔镜技术在恶性胆道肿瘤中应用的重要保障。

Surgical resection is the main treatment for intrahepatic cholangiocarcinoma,its characteristics will change in the new era of multidisciplinary treatment.Intrahepatic cholangiocarcinoma has a strong invasion and metastasis ability,mainly along Glisson's sheath or lymphatic system,so anatomic resection based on portal vein drainage area is of more oncology significance.With the development of laparoscopic visualization technology,laparoscopic anatomic liver resection and regional lymphatic dissection may be more technical advantage.Preliminary studies show that compared with open surgery,laparoscopic surgery have a better perioperative curative effect and the possible effect of oncology,but it still need to accumulate more cases and randomized controlled studies for further evaluation.Strict control of indications,experienced doctors,excellent equipment and homogeneous surgical principle are important guarantees for safe exploration of the application of laparoscopy in malignant biliary tumors.