腹腔镜肝切除手术治疗肝细胞癌的若干问题探讨

Exploring some issues of laparoscopic hepatectomy for hepatocellular carcinoma

由于肝脏解剖的复杂性和手术操作的风险性,腹腔镜肝切除术仍是具有较高技术挑战的微创手术方式。腹腔镜肝切除术前需对患者的全身状况、肝脏储备功能以及手术入路的选择进行充分评估,方能达到最佳的治疗效果。相较于开腹手术,腹腔镜肝切除术治疗肝细胞癌的优势已得到广泛认可。解剖性肝切除术、流域切除技术和精准肝切除理念的提出,推动了肝脏微创外科的全面发展。腹腔镜术中吲哚菁绿荧光联合超声引导、肝脏分隔和门静脉结扎的二步肝切除方法、术中控制性低中心静脉压等技术的革新,使得腹腔镜肝切除技术有望为肝细胞癌手术治疗带来新的突破。虽然腹腔镜肝切除术治疗肝细胞癌患者数量呈明显增多趋势,但目前国内外对于该技术推广应用的诸多问题仍未达成共识。本文就腹腔镜切除手术治疗肝细胞癌的入路选择、手术适应证与禁忌证、理念转变、技术革新、并发症的防控等问题作一简要探讨。

Due to the complexity and risk of liver anatomy and operation,laparoscopic hepatectomy is still a challengeable procedure.In order to acquire the optimal treatment effect,we need to comprehensively analyze the general condition,hepatic reserve function of patients,and the pathway selection before this surgery.Compared with open hepatectomy,the advantage of laparoscopic hepatectomy for hepatocellular carcinoma has been widely recognized.Anatomical hepatectomy,regional resection technology,and precise hepatectomy promote the all-round development of minimal invasive liver surgery.With the navigation of indocyanine green and laparoscopic ultrasound,and the support of associating liver partition and portal vein ligation for staged hepatectomy,controlled low central venous pressure and other technologic revolution,laparoscopic hepatectomy is believed to bring new breakthrough in treatment of HCC.Although the number of HCC patients who underwent laparoscopic resection of is increasing,there are still numbers of problems,referred to technology applied and promoted,at home and abroad.This article aims to discuss the pathway selection,surgical indications and contraindications,transformation of concepts,technology annotation,and the control of complications in HCC treatment.