人工智能时代肝胆胰外科微创技术与开放手术之争

Debate between minimally invasive and open hepatopancreatobiliary surgery in the era of artificial intelligence

现今从技术层面来看,腹腔镜与机器人已可以完成几乎所有的开放肝胆胰手术,并且经多项前瞻性RCT研究认为:微创胰十二指肠切除术和肝切除术的术后恢复更好,但对术后远期疗效的影响仍不明显,其学习曲线期间手术并发症发生率较开放手术高。多部指南与共识建议:仅在高流量大型专科单位由经验丰富且已度过学习曲线的专科医生施行微创肝胆胰高难度手术,同时专业学会应强化技术监管和审批,合理选择手术适应证,做好开放与微创技术的深度融合,不断改善手术质量使病人获益。

Technically, almost all open hepatopancreatobiliary surgeries can be performed with laparoscopy or robotics.Prospective RCT studies have demonstrated that postoperative recovery is better in patients undergoing minimally invasive pancreatoduodenectomy or hepatectomy than those undergoing traditional open surgery. Although the impact of minimally invasive surgery on the long-term outcomes is still unclear, the surgical complications during the learning curve period are higher than in those of open surgery. Guidelines and consensus have recommended that the complex minimally invasive hepatopancreatobiliary surgery should be carried out in highvolume centers by experienced surgeons only, who have accomplished the learning curve period. Additionally,professional associations should strengthen supervision and approval, select surgical indications reasonably, make open and minimally invasive techniques complement each other,and improve the quality of surgery to benefit patients.