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腹腔镜限量解剖性肝切除术的理念与实践 被引量:13

Concept and practice of laparoscopic limited anatomical hepatectomy
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摘要 腹腔镜解剖性肝切除术已成为肝细胞癌的治愈性治疗措施之一,从外科学和肿瘤学的角度,都被证实能给患者带来微创和生存双重获益。我国肝细胞癌患者>80%合并肝硬化,肝脏储备功能受损,肿瘤常跨越肝段生长、累及多个肝段,传统腹腔镜解剖性肝切除术因切除肝脏体积较大,容易导致术后肝衰竭而应用受限。基于肝细胞癌的肿瘤生物学特性和传统腹腔镜解剖性肝切除术的局限性,腹腔镜限量解剖性肝切除术的理念应运而生并用于实践。腹腔镜限量解剖性肝切除术又称保留肝实质的解剖性肝切除术,是指以肿瘤病灶为中心,以荷瘤门静脉流域为参考平面,根据肿瘤所在位置及其与亚肝段和(或)肝段的解剖关系,切除肿瘤及其所在亚肝段和(或)肝段门静脉流域,其核心理念是在保证肿瘤学安全的前提下,最大限度保留功能性肝实质。腹腔镜限量解剖性肝切除的手术方式包括解剖性亚肝段切除、肝段切除和保留肝实质的联合亚肝段和(或)肝段切除术,其适应证主要是位于(亚)肝段之间的小肝癌或微小肝癌,采用三维可视化、腹腔镜超声检查和吲哚菁绿融合荧光等导航技术,通过多个亚肝段的拼接组合,实现以肿瘤病灶为中心、以切缘为本的解剖性肝切除术,可以达到既最大限度切除荷瘤门静脉流域的肝组织,又最大限度保留功能性肝脏结构和体积的目的。目前腹腔镜限量解剖性肝切除术治疗肝细胞癌尚处于探索阶段,其远期肿瘤学结果有待进一步研究。随着技术进步和理念更新,腹腔镜限量解剖性肝切除术将成为肝细胞癌微创精准治疗的核心手段。笔者综合分析国内外相关研究,深入阐述腹腔镜限量解剖性肝切除术的概念与发展沿革、理论和技术支持、肿瘤学安全性及发展趋势等方面的研究现状。 Laparoscopic anatomic hepatectomy has become one of the therapeutic measures for hepatocellular carcinoma(HCC),which has been proven to bring both minimally invasive and survival benefits to patients from both surgical and oncological perspectives.More than 80%of HCC patients in China are complicated with cirrhosis,and the liver reserve function is impaired.Tumors often grow across liver segments or involve multiple segments.However,the application of tradi-tional laparoscopic anatomic hepatectomy is limited due to the large volume of liver resection,which is prone to lead to postoperative liver failure.Based on the bio-oncological characteristics of HCC and the limitations of traditional laparoscopic anatomical hepatectomy,the concept and practice of laparoscopic limited anatomical hepatectomy(LLAH)came into being.LLAH,also known as hepatic parenchyma-preserving anatomical hepatectomy,is based on the tumor lesion as the center,the portal territory with tumor as the reference plane,and anatomical relationship between tumor location and the sub-hepatic segment or hepatic segment as the principle to remove the tumor and its subsegment or hepatic segmental portal territory.Its core concept is to maximize the preser-vation of functional liver parenchyma on the premise of ensuring oncological resection.The main surgical procedures of LLAH include anatomical subsegmental resection,segmentectomy and combined subsegmental/segmental resection with preservation of liver parenchyma.Its main indica-tion is small or micro hepatocellular carcinoma located between subsegments/segments.Navigation technologies such as three-dimensional visualization,laparo-scopic ultrasound,and indocyanine green fusion fluorescence are used to achieve anatomical hepatectomy with tumor and its oncolo-gical safety margin as the center through the splicing and combination of multiple subsegments/segments.The purpose of resection of the liver tissue in the portal territory with tumor and preser-vation of the functional liver structure and volume are achieved to the maximum extent after LLAH.At present,LLAH for HCC is still in the exploratory stage,and its long-term oncology results need to be further studied.However,with technological progress and concept update,LLAH will surely become the core method for minimally invasive and precise treatment of HCC.Combined with related researches at at home and abroad,the authors describe the concept and development,theoretical and technical supports,oncological safety and development trends of LLAH.
作者 郑树国 旷钥文 Zheng Shuguo;Kuang Yuewen(Institute of Hepatobiliary Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China)
出处 《中华消化外科杂志》 CAS CSCD 北大核心 2022年第5期586-590,共5页 Chinese Journal of Digestive Surgery
基金 国家自然科学基金面上项目(81972303)。
关键词 肝肿瘤 限量肝切除 解剖性肝切除 外科 外科手术 腹腔镜检查 Liver neoplasms Limited hepatectomy Anatomical hepatectomy Surgery Surgical procedures,operative Laparoscopy
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