科学肝切除与个体化治疗:最大化患者获益的创新实践  

Scientific liver resection and personalized treatment:innovative practices to maximize patient benefits

作　　者：武志鹏 杜刚[2] 刘泽阳[2] 张赛 杨梦凡 刘铭坤 靳斌 WU Zhipeng;DU Gang;LIU Zeyang;ZHANG Sai;YANG Mengfan;LIU Mingkun;JIN Bin(Department of Hepatobiliary Surgery,the Second Hospital of Shandong University,Ji'nan 250001,China;Department of Organ Transplantation,Qilu Hospital of Shandong University,Ji'nan 250012,China;Shandong Provincial Engineering Research Center for Multidisciplinary Interdisciplinary Research on Hepatobiliary and Pancreatic Malignant Tumors,Ji'nan 250001,China)

机构地区：[1]山东大学第二医院肝胆外科,山东济南250001 [2]山东大学齐鲁医院器官移植科,山东济南250012 [3]肝胆胰恶性肿瘤多学科交叉研究山东省工程研究中心,山东济南250001

出　　处：《中国普通外科杂志》2025年第1期54-61,共8页China Journal of General Surgery

摘　　要：原发性肝癌,特别是肝细胞癌,是我国常见的恶性肿瘤之一,肝切除仍然是主要的根治性治疗方法。然而,由于肝癌的异质性、易复发以及大部分患者在初诊时已处于中晚期的特点,肝切除治疗的效果受到很大限制。近年来,精准医疗的发展为肝癌治疗带来了新希望,尤其在术前评估、系统治疗、微创手术和个体化治疗策略方面取得了显著进展。术前评估包括影像学技术如三维可视化和分子影像技术的应用,帮助医生精准评估肿瘤特征和肝功能,指导治疗方案选择。免疫治疗与靶向治疗的联合应用显著提高了晚期肝癌患者的生存期。系统治疗联合局部治疗的策略为转化治疗提供了新途径,扩大了肝切除适应证。如何根据患者肿瘤生物学特性,特别是分子特征分型和肝功能状态,选择最佳获益人群仍需进一步探索。“七步法”模块化腹腔镜肝切除术通过科学性肝切除实现患者最大化获益的临床实践进一步阐明了以外科治疗为主的多学科综合性个体化治疗模式。Primary liver cancer,particularly hepatocellular carcinoma,is one of the most common malignancies in China,and hepatectomy remains the primary curative treatment.However,the efficacy of hepatectomy is significantly limited due to the heterogeneity of liver cancer,its high recurrence rate,and the fact that most patients are diagnosed at advanced stages.In recent years,the development of precision medicine has brought new hope to liver cancer treatment,especially with notable advancements in preoperative assessment,systemic therapy,minimally invasive surgery,and personalized treatment strategies.Preoperative assessment,including imaging technologies such as three-dimensional visualization and molecular imaging,helps physicians accurately evaluate tumor characteristics and liver function,guiding the choice of treatment plan.The combined application of immunotherapy and targeted therapy has significantly improved survival rates for patients with advanced liver cancer.The strategy of combining systemic therapy with local treatment has provided new pathways for translational therapy,expanding the indications for hepatectomy.The optimal selection of patients based on tumor biological characteristics,especially molecular subtyping and liver function status,to maximize patient benefit still requires further exploration.The "seven-step" modular laparoscopic hepatectomy,by achieving scientific hepatectomy,demonstrates the clinical practice of maximizing patient benefit,further elucidating a multidisciplinary,personalized treatment model centered on surgical therapy.

关 键 词：肝肿瘤 肝切除术 精准医学 腹腔镜 

分 类 号：R735.7[医药卫生—肿瘤]