复杂肝脏手术实施的难点与技术进步  

Recent advances and difficulties in techniques of the complex and extended liver resection

作　　者：陈孝平[1] 何松青[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,湖北武汉430030

出　　处：《中国实用外科杂志》2010年第8期629-632,共4页Chinese Journal of Practical Surgery

摘　　要：肝脏外科的进展大大增加了各种肝切除手术的安全性,使复杂性肝切除得以安全地开展。这些进步归功于术前CT对肿瘤血管及胆管的重建与评估、术中B超的应用等增加了对肝脏解剖的认识,采用更好的术中血流阻断技术以及旨在控制肝断面出血的新型断肝器械的应用。术前门静脉栓塞可能增加正常肝脏的体积从而提高复杂肝切除术的安全性。术中麻醉控制性低中心静脉压以及选择性出入肝血流阻断安全有效。手术、局部化疗以及局部消融治疗的联合应用扩大了手术切除的适应证。对疾病分期的评估有效性以及新型腹腔镜断肝器械的有效应用开拓了腹腔镜在肝脏外科领域的应用。随着技术与设备的进步,腹腔镜与机器人外科将在复杂肝切除占有一席之地。Advances in liver surgery have increased the safety of all types of liver reseetions and have made complex and extended hepateetomy performed successfully with low operative mortality. The progresses achieved are attributable to an improved understanding of hepatic anatomy using computer-aided reconstruction of the tumor zones,vascular and biliary anatomy, intraoperative ultrasound and other new imaging technologies and a better method of vascular clamping, vascular reconstruction and better techniques and instruments to achieve more precise liver transection with a good haemostasis on the cut surface. Preoperative manipulation of the liver volume with hypertrophy of the future liver remnant （portal vein embolization） has made complex and extended hepatectomies feasible. Control bleeding during hepatic resection using low CVP anesthesia with selectivevascular inflow and outflow control before parenchymal transection is a safe, reliable and effective approach. Complex combinations of surgery, chemotherapy and local ablation are used in advanced disease, extended the limits of resectability for liver tumors. Hepatic laparoscopic surgery is gaining popularity due to the useful for staging purposes and the availability of new laparoscopic instruments for liver transection. Advances in laparoscopie equipment and techniques and telerobotic surgery will undoubtedly expand the use of the techniques and become the next frontier in hepatic complex resectional surgery.

关 键 词：肝切除术 肝脏血流阻断 断肝器械 

分 类 号：R6[医药卫生—外科学]