从成人到小儿:精准肝脏外科的发展与展望  

From adult to child:the development and prospect of precision liver surgery

作　　者：朱呈瞻 董蒨[2] Zhu Chengzhan;Dong Qian(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Pediatric Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肝胆胰外科,266003 [2]青岛大学附属医院小儿外科,266003

出　　处：《中华消化外科杂志》2021年第12期1272-1277,共6页Chinese Journal of Digestive Surgery

基　　金：国家十二五科技支撑计划(2013BAI01B03);山东省自然科学基金面上项目(ZR2021 MH171)

摘　　要：精准医学理念的提出给人类健康、医疗带来革命性变化。广义的精准医学是将基因测序、数字医学、人工智能、导航技术及生物医学工程等先进技术应用于临床、基础、公共卫生等医学研究与实践, 目的是推动医学水平不断发展。而精准外科理念最早由董家鸿院士提出, 其在肝脏外科领域的应用对肿瘤及外科其他专业领域起到示范作用。计算机辅助手术系统的研发与应用推动了精准肝脏外科的发展, 数字肝脏三维重建为肝脏血管解剖及肝脏分段提供新依据, 辅助实现个体化手术规划, 剩余肝脏体积测量保障手术的安全性。成人精准肝脏外科的巨大进步为小儿肝脏外科的发展提供了重要帮助和引导。小儿肝脏肿瘤与成人相比有其特殊性, 通常瘤体巨大、部位复杂、生长迅速、恶性程度高。但小儿多不合并肝硬化, 对化疗敏感, 肝脏体积随着年龄和体质量变化发生很大变化, 这些差异决定了小儿肝脏肿瘤的治疗需要采取不同模式, 尚有待完善诊断与治疗规范。笔者深入阐述从成人到小儿:精准肝脏外科的发展与展望, 以促进肝脏肿瘤的精准手术与综合治疗。The concept of precision medicine has brought revolutionary changes to human health and medical treatment.In a broad sense,precision medicine is the application of advanced technologies such as gene sequencing,digital medicine,artificial intelligence,navigation technology,and biomedical engineering to clinical,basic,and public health medical research and practice.The purpose is to promote the continuous development of medical standards.The concept of precision surgery was first proposed by academician Dong Jiahong,who has played an exemplary role in the field of liver surgery for the oncology and other professional fields of surgery.The development and application of computer-assisted surgery systems have promoted the development of precision liver surgery.The digital liver three-dimensional reconstruction provides a new basis for liver vascular anatomy and liver segmentation,assists in the realization of individualized surgical planning,and the measurement of residual liver volume guarantees the safety of operation.The great progress of adult precision liver surgery has provided important help and guidance for the development of pediatric liver surgery.Compared with adults,pediatric liver tumors have their particularities.Pediatric liver tumors are often huge,complex in location,fast growing,and highly malignant.Most children do not have liver cirrhosis and are sensitive to chemotherapy.The liver volume changes greatly with age and weight.These differences determine that the treatment of liver tumors in children needs to adopt different models,and the diagnosis and treatment standards need to be improved.The authors elaborate on the topic of"from adult to child-the development and prospect of precision liver surgery"to promote precision surgery and comprehensive treatment of liver tumors.

关 键 词：肝肿瘤 小儿 肝脏分段 肝脏体积 肝切除 精准外科 

分 类 号：R657.3[医药卫生—外科学] R726.5[医药卫生—临床医学]