切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 363 -368. doi: 10.3877/cma.j.issn.1674-3946.2021.04.003

所属专题: 述评/论坛 总编推荐

专家论坛

中国腹腔镜肝癌手术20年演变历程与成就
叶于富1, 陈伟1, 白雪莉1,()   
  1. 1. 310006 杭州,浙江大学医学院附属第一医院肝胆胰外科 浙江省肝胆胰疾病临床医学研究中心
  • 收稿日期:2021-04-26 出版日期:2021-08-17
  • 通信作者: 白雪莉

Evolution and achievements of laparoscopic hepatocellular carcinoma in China over the past 20 years

Yufu Ye1, Wei Chen1, Xueli Bai1,()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine; Zhejiang Provincial Clinical Research Center for the Study of Hepatobiliary & Pancreatic Diseases, Hangzhou 310006, China
  • Received:2021-04-26 Published:2021-08-17
  • Corresponding author: Xueli Bai
  • Supported by:
    The Natural Science Foundation of China(81871925, 82071867); Key research and development Project of Zhejiang Province(2020C03117)
引用本文:

叶于富, 陈伟, 白雪莉. 中国腹腔镜肝癌手术20年演变历程与成就[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(04): 363-368.

Yufu Ye, Wei Chen, Xueli Bai. Evolution and achievements of laparoscopic hepatocellular carcinoma in China over the past 20 years[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 363-368.

随着技术进步和经验积累,腹腔镜肝切除已经成为标准术式。中国是肝癌大国,近20年来,腹腔镜肝癌手术跨越"理念和技术双重障碍",历经探索、发展和优化,从最初的边缘楔形切除发展到半肝切除、扩大半肝切除、肝中叶切除、再到精准解剖性肝切除,其技术方法不断完善,标准化操作体系初步形成,从外科学和肿瘤学角度,都被证实能给患者带来"微创和生存双重优势"。如今,手术相关技术日新月异,系统治疗药物层出迭见,新的格局新的挑战,中国腹腔镜肝癌手术正大踏步进入新的时代,未来可期。

With progress of technique and accumulation of experience, laparoscopic liver resection (LLR) has become a standard operation. China is a country with high incidence of hepatocellular carcinoma (HCC). In the past 20 years, LLR has overcome "double barriers of concept and technique" . After exploration, development and optimization, it evolves from initial wedge resection to hemihepatectomy, extended hemihepatectomy, mesohepatectomy, followed by precise anatomical hepatectomy. With the continuous improvement of technical approaches, the standardized operation system of LLR has preliminarily taken shape. From the perspectives of surgical and oncological view, it has been proven to bring "dual advantages of minimal invasion and survival" to patients. At present, surgical techniques develop with each passing day, and systemic therapeutic drugs emerge in an endless stream. Along with new pattern and new challenge, China’s laparoscopic liver resection for HCC is striding into a new era with a brilliant future.

图1 肝癌行腹腔镜解剖性右后叶+右前叶腹段切除[(A)术前增强CT提示肿瘤位于肝右后叶,累及肝右静脉远端可能;(B)断肝平面为肝表面缺血线、右肝肝蒂/前裂静脉和下腔静脉构成的面;(C)离断右前肝蒂发出的VII段分支;(D)剖开标本见肿瘤周围多发子灶形成]
图2 肝癌行腹腔镜解剖性S7切除[(A)术前增强CT动脉期提示肿瘤位于VII段;(B)术前增强CT门脉期提示肿瘤位于VII段;(C)离断VII段肝蒂,断肝平面为肝表面缺血线、肝右静脉和下腔静脉构成的面;(D)剖开标本见切缘足够]
图3 肝癌行腹腔镜解剖性S8切除[(A)术前增强CT提示肿瘤位于VIII段;(B)基于CT影像的三维重建可清楚显示肿瘤和周边血管的关系,有利于术前制定详细的手术规划;(C)离断面可见肝右静脉(RHV)、肝中静脉(MHV)和VIII段的肝蒂腹侧支和背侧支(G8);(D)切除标本可见肿瘤具有完整的包膜]
图4 肝癌行腹腔镜ICG荧光正染解剖性S5切除[(A)术前增强磁共振提示肿瘤位于V段;(B)术前增强CT提示肿瘤位于V段;(C)腹腔镜下行V段门静脉穿刺,注入ICG行V段正染;(D)切除后的标本]
图5 吲哚菁绿荧光染色导航腹腔镜肝切除[(A)术前5d外周静脉注射ICG,术中可见左侧尾状叶肿瘤染色;(B)术中行V段门静脉穿刺,注射ICG行V段荧光正染;(C)离断右后支肝蒂后,术中通过外周静脉注射ICG行右后叶反染]
图6 肝癌转化治疗后行腹腔镜全尾状叶切除术[(A)术前增强CT提示肿瘤位于尾状叶,与周围血管关系欠清;(B)转化治疗后见肿瘤大部分坏死,与周边血管界限清晰;(C)腹腔镜全尾状叶切除后的标本;(D)离断面见下腔静脉(IVC)、右后肝蒂(RPP);(E)离断面见下腔静脉(IVC),左肝蒂(LP),肝左静脉(LHV)]
[1]
Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions[J]. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
[2]
Cho JY, Han H-S, Wakabayashi G, et al. Practical guidelines for performing laparoscopic liver resection based on the second international laparoscopic liver consensus conference[J]. Surg Oncol, 2018, 27(1): A5-A9.
[3]
Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka[J]. Ann Surg, 2015, 261(4): 619-629.
[4]
陈孝平,裴友亮,张万广. 腹腔镜肝癌根治术的热点与未来发展[J/CD]. 中华普外科手术学杂志(电子版),2019,13(3),217-219.
[5]
孙林茂,梁英健,刘连新. 腹腔镜肝段切除术的难点与策略[J/CD]. 中华普外科手术学杂志(电子版),2019,13(3),232-234.
[6]
曾永毅,刘景丰,黄光,等. 腹腔镜解剖性肝切除手术切面确定原则[J/CD]. 中华普外科手术学杂志(电子版),2019,13(3):220-223.
[7]
周伟平,孙志宏,吴孟超,等. 经腹腔镜肝叶切除首例报道[J]. 肝胆外科杂志,1994,2(2):82.
[8]
李朝龙,邹衍泰,于晓园,等. 腹腔镜肝肿瘤切除[J]. 现代临床普通外科,1996,1:33-34.
[9]
胡明根,刘荣,罗英,等. 腹腔镜肝切除治疗肝细胞癌123例临床分析[J]. 中华外科杂志,2008,46(23):1774-1776.
[10]
Lai ECH, Tang CN, Ha JPY, et al. Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center[J]. Arch Surg, 2009, 144(2): 143-147;discussion148.
[11]
Lai ECH, Tang CN, Yang GPC, et al. Minimally invasive surgical treatment of hepatocellular carcinoma: long-term outcome[J]. World J Surg, 2009, 33(10): 2150-2154.
[12]
蔡秀军,虞洪,郑雪咏,等. 腹腔镜右半肝切除一例[J]. 中华医学杂志,2005,85(13):869.
[13]
刘荣,胡明根,王刚. 完全腹腔镜肝右三叶切除一例[J]. 中华医学杂志,2005,85(25):1783.
[14]
刘荣,王悦华,周宁新,等. 腹腔镜左半肝切除术1例报告[J]. 中国实用外科杂志,2002,22(10):635.
[15]
Cheng KC, Yeung YP, Hui J, et al. Multimedia manuscript: laparoscopic resection of hepatocellular carcinoma at segment 7: the posterior approach to anatomic resection[J]. Surg Endosc, 2011, 25(10): 3437.
[16]
Xiang L, Xiao L, Li J, et al. Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments[J]. World J Surg, 2015, 39(5): 1202-1209.
[17]
Xiao L, Xiang L-J, Li J-W, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments[J]. Surg Endosc, 2015, 29(10): 2994-3001.
[18]
Cheung TT, Lo CM. Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis[J]. Hepatobiliary Surg Nutr, 2015, 4(6): 406-410.
[19]
Cheung TT, Poon RTP, Yuen WK, et al. Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience[J]. Ann Surg, 2013, 257(3): 506-511.
[20]
Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome[J]. Am J Surg, 2013, 205(6): 697-702.
[21]
Xu H, Liu F, Hao X, et al. Laparoscopically anatomical versus non-anatomical liver resection for large hepatocellular carcinoma[J]. HPB (Oxford), 2020, 22(1): 136-143.
[22]
Takayama T, Nakatsuka T, Shimada K, et al. Function-preserving segmentectomy of the cirrhotic liver[J]. Hepatogastroenterology, 1995, 42(4): 415-417.
[23]
方驰华,张鹏,罗火灵,等. 增强现实导航技术联合吲哚菁绿分子荧光影像在三维腹腔镜肝切除术中的应用[J]. 中华外科杂志,2019,57(8):578-584.
[24]
蔡秀军,彭淑牖,虞洪,等. 完全腹腔镜下行ALPPS治疗伴肝硬化的原发性肝癌可行性临床探讨[J]. 中国实用外科杂志,2014,34(7):637-640.
[25]
曹君,张红卫,张磊,等. 腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究[J]. 中国实用外科杂志,2014,34(1):77-80.
[26]
郑树国,李建伟,肖乐,等. 全腹腔镜联合肝脏离断和门静脉结扎的二步肝切除术治疗肝硬化肝癌[J]. 中华消化外科杂志,2014,13(7):502-507.
[27]
Ciria R, Cherqui D, Geller DA, et al. Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing[J]. Ann Surg, 2016, 263(4): 761-777.
[28]
中国研究型医院学会肝胆胰外科专业委员会. 腹腔镜肝切除术治疗肝细胞癌中国专家共识(2020版)[J]. 中华消化外科杂志,2020,19(11):1119-1134.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?