腹腔镜肝切除术关键技术、难点及对策  

Key technique,challenge and strategy of laparoscopic hepatectomy

作　　者：蔡秀军[1] 蔡柳新[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,浙江杭州310016

出　　处：《中国实用外科杂志》2017年第5期461-465,共5页Chinese Journal of Practical Surgery

摘　　要：近年来,腹腔镜肝切除术发展迅速,成果斐然。由于器械的研制、技术的创新、术式的发展,其手术适应证不断拓宽,良恶性病灶甚至供体肝脏都能在腹腔镜下实施切除;腹腔镜肝切除的范围不断扩大,己由浅表病变的肝局部切除扩大到半肝乃至更大范围的解剖性切除。但腹腔镜肝切除术仍处于发展成熟阶段,缺乏标准术式、术中出血不易控制以及手术人员培养周期较长等问题制约着腹腔镜肝切除术的进一步发展。建立一个高效的培训体系,培养腹腔镜肝切除术专科医生,掌握出血控制、肝脏实质离断等关键技术,规范化实施腹腔镜肝切除术操作,是腹腔镜肝切除术普及和推广的关键。Rapid development has been made in laparoscopic liver resections in recently years, with great resuhs. With the rapid development of minimally invasive devices, innovation of new technique and concept, and with the improvement of operation, indications of laparoscopic hepatectomy continuesto expand, a variety of liver operations including benign or malignant lesions and even donor liver resection that used to be done in open surgery could be completed under laparoscopy. The resection scope of laparoscopy hepatectomy has expanded from local resection of superficial lesions to semi-hepatectomy and extended anatomic resection. However, the procedure is still in the stage of development, lacking of standard operation, with difficulty in controlling intraoperative bleeding and a long period of training surgeons, which restricts the further progress of laparoscopic hepatectomy. It is of great significance to establish an effective education system for the training of specialist, so as to master the key techniques of laparoscopic hepatectomy such as the hepatic vascular occlusion and bleeding control and liver parenchyma dissection, accelerating the standardization program of the operation, which is extremely important for the popularizing and spreading of laparoscopic hepatectomy.

关 键 词：腹腔镜 肝切除术 肝实质离断 肝血流阻断 术中出血 

分 类 号：R6[医药卫生—外科学]