肝胆胰外科新理念与新技术  

New concepts and techniques of hepato-pancreato-biliary surgery

作　　者：陈琳[1] 董为[1] 张必翔[1] 张志伟[1] 黄志勇[1] 陈义发[1] 罗鸿萍[1] 张万广[1] 梅斌[1] 肖震宇[1] 陈孝平[1] CHEN Lin DONG Wei ZHANG BiXiang ZHANG ZhiWei HUANG ZhiYong CHEN YiFa LUO HongPing ZHANG WanGuang MEI Bin XIAO ZhenYu ＆ CHEN XiaoPing(Key Laboratory of Organ Transplantation, National Health and Family Planning Commision,Key Laboratory of Organ Transplantation, Ministry of Education, Hepatic Surgery Clinical Research Centre of Hubei Province, Hepatic Surgery Centre, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Chin)

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,湖北省肝脏外科医学临床研究中心,教育部器官移植重点实验室,卫生部器官移植重点实验室,武汉430030

出　　处：《科学通报》2017年第1期36-46,共11页Chinese Science Bulletin

基　　金：国家科技重大专项(2012ZX10002016-004,2012ZX10002010-001-004)资助

摘　　要：外科手术是治疗肝胆胰肿瘤最有效和首选的方法,减少手术出血量、提高手术安全性、简化手术操作、降低并发症和死亡率,一直是肝胆胰外科领域研究的焦点.作为国内最早施行肝胆胰手术的中心之一,从20世纪80年代至今本课题组先后提出了一些新的理念:提出大肝癌和巨大肝癌手术切除的可行性理论并应用于临床,拓展了肝切除治疗肝癌的适应证;提出肝细胞癌新的分类方法,有利于针对大小不同的肿瘤选择不同的治疗方法和进行疗效评估;针对肝癌合并门静脉癌栓的不同类型,采取不同的手术方式,取得良好效果;肝切除联合脾切除治疗原发性肝细胞癌合并门静脉高压症.创立3种肝脏手术控制出血新技术:不解剖肝门经肝实质结扎入肝及出肝血流、第一肝门阻断联合肝下下腔静脉阻断、经肝裸区双悬吊法;小范围肝切除治疗肝门部胆管癌的新理念;不缝合胆管前壁的肝肠吻合术和插入式胆肠吻合术;新的"U"型胰肠套入式缝合法;世界首个原位辅助性部分肝移植手术方式,并成功应用于临床.Surgery is the most effective and preferred treatment for hepato-pancreato-biliary （HPB） tumors. The improvement of HPB surgery technique mainly focus on reducing the amount of bleeding, improving the safety of operation, simplifying the operation, reducing the complications and mortality all the time. As one of the largest HPB centers in China, hepatic center of Tongji hospital has set up a series of new concepts and new techniques of HPB surgery since 1980s. We proposed a new classification standard of hepatocellular carcinoma （HCC） to guide the surgical procedures and evaluation of prognosis. According to this method, HCCs lager than 5 cm were defined as lager （〉5 cm and 〈10 cm） or Huge HCC （≥10 cm）. Traditionally, the large/huge HCC patients were thought can＇t tolerate hepatectomy because of the insufficient residual liver volume. However, we confirmed the feasibility and safety of the resection of large/huge HCC and applied it in clinic concurrently in 1990s, which greatly extended the inclusion criteria for operation. Serious intraoperative bleeding is another constraint for resection of large/huge HCC. In order to reduce the intraoperative bleeding and increase the safety of major hepatectomies, three new bleeding control techniques for hepatectomy were established： Infrahepatic inferior vena cava clamping combine with occlusion of the portal triad; tying up of inflow and outflow vessels without dissecting the hilus of the liver; and implementation of the liver double-hanging maneuver through the retrohepatic avascular tunnel on the right side of the inferior vena cava. According to the AASLD and the EASL guidelines for HCC management, patients with portal vein tumor thrombosis （PVTT） are excluded from either surgical treatment or TACE, and only palliative therapies are recommended. However, our studies confirmed treating PVTT patient by indicated surgical protocol according to the location and extension of PVTT is safety and effective. Based on the guideline set by western co

关 键 词：肝切除 原发性肝癌 肝门部胆管癌 胆肠吻合 胰十二指肠切除术 胰肠吻合 原位辅助性部分肝移植 

分 类 号：R656[医药卫生—外科学]