转化医学时代腹腔镜肝切除术治疗肝癌时机及关键问题  

Timing and key issues of laparoscopic hepatectomy for liver cancer in the era of translational medicine

作　　者：刘连新 孟凡征 LIU Lian-xin;MENG Fan-zheng(Department of Hepatobiliary Surgery,Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery,Anhui Provincial Clinical Research Center for Hepato-biliary Diseases,the First Affiliated Hospital of University of Sci-ence and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)肝胆外科,肝胆胰外科安徽省重点实验室,安徽省肝胆疾病临床医学研究中心,安徽合肥230001

出　　处：《中国实用外科杂志》2022年第9期975-978,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.82103219,No.81972307);安徽省自然科学基金(No.2108085QH343);科大新医学联合基金项目(No.WK9110000153)。

摘　　要：原发性肝癌恶性程度高,大多数肝细胞癌病人确诊时已丧失了手术切除机会。根治性手术切除仍是肝癌病人获得长期生存甚至治愈的主要手段。依托多维度、系统化以及个体化的多学科综合治疗协作组模式,中晚期肝癌的治疗已进入精准转化医学时代,既包括外科可切除性的转化,又涉及到向肿瘤学获益的转化,以期进行安全的R0根治性肝切除术。腹腔镜肝切除术具有创伤小和术后恢复快等优势,在肝癌转化治疗后病人手术选择中仍占重要位置。转化医学时代腹腔镜治疗肝癌转化治疗后病人术前需精细评估(肿瘤缓解情况以及能否R0切除),综合考虑肝脏损伤情况(炎症、粘连、再生潜力等)来确定病人选择及最佳手术时机。要将病人的安全放在首位,同时做到标准、规范、确保疗效及微创,从而最大程度使病人生存获益。Primary liver cancer is highly malignant,and most patients with hepatocellular carcinoma(HCC)have already lost the chance of surgical resection when they are diagnosed.Radical surgical resection is still the main method for long-term survival and even cure for HCC patients.Based on the multidimensional,systematic and individualized multidisciplinary team,the treatment of advanced HCC has entered the era of precision conversion therapy,which not only involves the conversion to surgical resection but also includes the transformation to oncological benefits.Laparoscopic hepatectomy has the advantages of less trauma and faster postoperative recovery,which is still an important surgical choice for HCC patients with conversion therapy.Laparoscopic hepatectomy of HCC patients requires precise preoperative evaluation(tumor remission and whether R0 resection is possible),and comprehensive consideration of liver damage(inflammation,adhesion,regeneration potential,etc.)to determine the patient selection and the best timing for operation.The safety of the patients should be the first priority,while achieving standards,norms,ensuring efficacy and minimally invasive,to maximize the survival benefit of patients.

关 键 词：肝细胞癌 转化治疗 多学科综合治疗协作组 腹腔镜肝切除 

分 类 号：R6[医药卫生—外科学]