腹腔镜肝癌切除术的肿瘤学风险及对策  

Laparoscopic hepatectomy for primary liver cancer:oncological risk and strategy

作　　者：梁霄[1] 杨再博 LIANG Xiao;YANG Zaibo(Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310000,China)

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310000

出　　处：《中国实用外科杂志》2022年第9期979-982,共4页Chinese Journal of Practical Surgery

基　　金：浙江省重点研发计划(No.2021C03127);国家自然科学基金(No.82072625);浙江省医药卫生科技计划省部共建重点项目(No.WKJ-ZJ-2030)。

摘　　要：原发性肝癌是最常见的恶性肿瘤之一,肝切除术仍然是其最主要的治疗手段。腹腔镜手术拥有创伤小、术中出血少、术后恢复快等优点,与开放手术相比,腹腔镜肝切除术(LH)在R0切除率及切缘距离方面差异无统计学意义,其术后生存率甚至优于开放手术。虽然腹腔镜手术缺乏对病变的直接触摸探查,无法直接判断肿瘤边界,但随着三维重建、腹腔镜超声、吲哚菁绿(ICG)荧光导航技术的应用,实现R0切除并不困难。如CO_(2)气腹、超声刀等被认为可能与肿瘤播散有关,但目前证据表明LH引起的肿瘤种植是极少见的。因此,LH治疗原发性肝癌在肿瘤学上安全可行,并不会增加肿瘤播散风险。Primary liver cancer is the most common malignancy which liver resection is still the mainly curative approach.Laparoscopic surgery,with advantages like a minimal invasion,less intraoperative blood loss,and faster postoperative recovery,has been widely accepted as the standard of the treatment of primary liver cancer.The chance of R0 resection and the width of the surgical margin of laparoscopic hepatectomy(LH)is comparable with the open procedure,while the postoperative survival is even better.Despite a lack of palpation of the lesion to determine the margin of the tumor,with the advance in 3D reconstruction,laparoscopic ultrasound,and indocyanine green(ICG)fluorescence navigation,it is feasible to perform an R0 resection.It was considered that the use of CO_(2)pneumoperitoneum and harmonic scalpel may be associated with tumor spread,however,the evidence showed that tumor implants induced by LH were rare.Therefore,the oncological outcome of LH in treating primary liver cancer is acceptable with little risk of tumor spread.

关 键 词：原发性肝细胞癌 腹腔镜肝切除术 肿瘤学风险 R0切除 肿瘤种植 

分 类 号：R6[医药卫生—外科学]