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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

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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]. 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]. 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)]
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