腹腔镜解剖性肝切除手术入路选择  

The choice of surgical approach in anatomic laparoscopic hepatectomy

作　　者：肖亮[1] 周乐杜[1] XIAO Liang;ZHOU Ledu(Department of Liver Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院肝脏外科,湖南长沙410008

出　　处：《中国普通外科杂志》2021年第1期9-15,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81771932)。

摘　　要：腹腔镜解剖性肝切除术(ALH)是普通外科难度较大的手术之一,这是由于腹腔镜下操作空间有限,肝脏作为人体内最大的实质性脏器,较难翻动和显露。另外,肝脏的血供丰富,肝内脉管结构纵横交错,肝实质解剖过程中容易发生难以控制的出血,从而被迫中转开腹,也因此导致ALH需要较长的学习曲线。虽然历经近30年的发展,目前国内较大的医疗机构都已开展该类手术,但对ALH成功实施的基础与前提——手术入路的个体化选择的系统性阐述不多。笔者针对这一问题进行探讨。Anatomic laparoscopic hepatectomy(ALH)is one of the most difficult operations in general surgery.Being restricted by the limited operation space of laparoscopic surgery,the liver,as the largest solid organ in the human body,is difficult to manipulate and expose.In addition,uncontrollable bleeding is likely to occur during the process of liver parenchyma dissection because of the abundant blood supply of the liver and the complex structure of the intrahepatic vessels,which may lead to a forced conversion to open surgery,and therefore cause a long learning curve to achieve the skill for ALH.Although after nearly 30 years of development as well as this operation has been carried out in most large medical institutions in our country,there are few systematic explanations for the selection of individualized surgical approach,which is the premise and basis for successful implementation of ALH.Here,the authors discuss the issues about this topic.

关 键 词：肝切除术 腹腔镜 肝肿瘤 手术技术 

分 类 号：R657.3[医药卫生—外科学]