肝内胆管癌微创外科治疗的现状及争议  

Current status and ongoing controversies of mini-invasive surgery for intrahepatic cholangiocarcinoma

作　　者：次仁平措 王超 何正为 丹增阿旺 张斌豪 Ciren Pingcuo;Wang Chao;He Zhengwei;Danzeng Awang;Zhang Binhao(Center of Hepatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,湖北武汉430030

出　　处：《腹部外科》2024年第2期140-145,共6页Journal of Abdominal Surgery

基　　金：湖北省陈孝平科技发展基金会(CXPJJH122005-20、CXPJJH121001-2021004、CXPJJH11900001-2019325)。

摘　　要：肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)是一种肝胆管恶性肿瘤,病因尚未明确。ICC侵袭性强且早期常无明显症状,病人就诊时分期往往较晚,因此仅有少部分早期病人接受根治性肝切除。微创外科近年来逐渐发展。就ICC的微创外科治疗而言,其包括微创肝切除(腹腔镜下肝切除、机器人辅助下腹腔镜肝切除)以及微波消融、介入治疗等手段。研究发现腹腔镜下肝切除相比于传统开腹肝切除,前者的ICC病人术后住院时间缩短,术中出血情况更为轻微,且两组淋巴结切除率及清扫数量未见明显差异;但亦有研究对ICC治疗中淋巴结清扫的必要性及其在腹腔镜下的可行性存疑。机器人辅助腹腔镜下肝切除可以使肝部分切除的操作更充分,利于胆道重建,提供的三维立体术野颇有价值。微创肝切除组的淋巴结清扫数量与开腹组相当、手术时间和术后住院时间均明显缩短于开腹组。此文针对ICC的微创肝切除抉择获益、切除范围以及淋巴结清扫等方面的争议展开叙述。Intrahepatic cholangiocarcinoma(ICC)is a malignant tumor of the liver bile ducts,with an unclear etiology.ICC is highly invasive and often asymptomatic in the early stages,leading to late-stage diagnosis and limited opportunities for curative liver resection in early-stage patients.Minimally invasive surgery has been gradually advancing in the treatment of ICC,including laparoscopic liver resection,robot-assisted laparoscopic liver resection,microwave ablation,and interventional therapy.Studies have shown that compared to traditional open liver resection,laparoscopic liver resection in ICC patients results in shorter postoperative hospital stays,less intraoperative bleeding,with comparable lymph node dissection rates.Controversies exist regarding the necessity and feasibility of lymphadenectomy in minimally invasive treatment of ICC.Robot-assisted laparoscopic liver resection allows for more comprehensive liver resection and facilitates bile duct reconstruction,providing valuable three-dimensional surgical views.The number of lymph nodes removed in minimally invasive liver resection is similar to open surgery,with significantly reduced operating time and postoperative hospital stays compared to open surgery.This article discusses the benefits and controversies surrounding minimally invasive liver resection for ICC,including the extent of resection and lymph node dissection.

关 键 词：肝内胆管癌 腹腔镜 肝切除术 机器人辅助腹腔镜下肝切除 

分 类 号：R735.7[医药卫生—肿瘤]