“门理论”在微创解剖性肝切除术中的应用与展望  

Application and prospects of“gate theory”in minimally invasive anatomical hepatectomy

作　　者：杨陈凤麟 李尧 王鑫 陈品初 王恺[1] 王泽桐 张起帆[1] YANG Chen-feng-lin;LI Yao;WANG Xin;ZHANG Qi-fan(Department of Hepatobiliary Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院肝胆外科,广东广州510515

出　　处：《中国实用外科杂志》2024年第3期341-345,共5页Chinese Journal of Practical Surgery

基　　金：广东省自然科学基金面上项目(No.2021A151511015)。

摘　　要：“门理论”由Atsushi Sugioka基于Laennec膜解剖结构提出,目前在肝胆外科领域得到了广泛的关注和应用。该理论通过定位肝蒂的“门”,并在此基础上实现肝蒂的快速、精准、安全的阻断,从而显著提高了肝切除手术的效率,并提升了手术的安全性和有效性。但由于生理和解剖的个体差异以及临床需求的多元性,经典的"门理论"在具体实施中难免存在一定的局限性。为此,南方医科大学南方医院肝胆外科团队提出了“泛门理论”该理论强调在遵循个体差异的基础上,以手术需求为导向,灵活设定并贯通“所想所需”的“门”,从而实现更精准的、个体化的微创解剖性肝切除(MIALR)。该理念在实践中得到了有效的验证,特别是在处理右侧肝蒂的解剖和手术中,表现出了较好的效果和优势。“门理论”为MIALR提供了重要的理论基础和技术支持,但仍需在实践中不断完善和发展,以适应不断变化和发展的外科新技术和新理念,实现真正意义上的精准医疗。The“Gate Theory,”proposed by Atsushi Sugioka based on Laennec's membranous anatomical structure,has received widespread attention and application in the field of hepatobiliary surgery.This theory allows for swift,precise,and safe occlusion of the hepatoduodenal ligament by locating its“gate”,significantly optimizing the effects of hepatic resection surgery and improving the safety and effectiveness of the operation.However,due to individual differences in physiology and anatomy and the diversity of clinical needs,the classic“ate Theory”inevitably has certain limitations in its implementation.Therefore,the hepatobiliary surgery team of Nanfang Hospital of Southern Medical University proposed the“Pan-Gate Theory.”This theory emphasizes that based on individual differences and with surgical needs as the guide,it flexibly sets and penetrates the“gate”as“esired and needed”,achieving a more precise and individualized minimally invasive anatomical liver resection(MIALR).This concept has been effectively validated in practice,especially in handling the anatomy and surgery of the right hepatoduodenal ligament,demonstrating good effects and advantages.The“Gate Theory”provides an important theoretical basis and technical support for MIALR,but it needs to be continuously improved and developed in practice to adapt to the constantly changing and developing new surgical techniques and concepts,achieving precision medicine in the true sense.

关 键 词：门理论 解剖性肝切除 Laennec膜 

分 类 号：R6[医药卫生—外科学]