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困难部位肝肿瘤腹腔镜肝切除手术要点
Key operating points of laparoscopic hepatectomy for liver tumor in difficult locations
文章发布日期:2020年11月13日  来源:  作者:张中林,袁玉峰  点击次数:2972次  下载次数:37次

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【摘要】:腹腔镜肝切除手术具有创伤小、应激反应轻、术后恢复快等优点。位于肝脏右后上区(Ⅶ、Ⅷ、Ⅳa段)及尾状叶区的肿瘤因位置深在,毗邻结构复杂,在腹腔镜下视野受限,暴露困难等原因,给手术操作带来极大的风险,被认为是腹腔镜肝脏手术的“困难部位”。近年来,随着腹腔镜肝脏手术技术、理念的进步,手术器械、设备的更新换代及三维可视化技术的应用,使位于“困难部位”的肝脏肿瘤在腹腔镜下切除成为可能。笔者团队根据自己中心经验,总结肝脏“困难部位”腹腔镜手术的技术要点,包括术前充分评估,合理规划手术,术中利用体位与戳孔布局,充分显露手术视野,对出血风险的预估和防控,综合运用各种新技术精准定位肿瘤,引导肝实质的离断,并结合训练有素的手术麻醉团队,可保证“困难部位”腹腔镜肝切除手术的安全性和有效性。
【Abstract】:Laparoscopic hepatectomy has the advantages of little trauma, mild stress response, and rapid postoperative recovery. Due to the deep location and complex structure, tumors located in the upper right posterior areas of the liver (Ⅶ, Ⅷ, and Ⅳa segments) and the caudate lobe have limited surgical field and difficult exposure under laparoscopy, which brings great risk to surgical operation, and these locations are considered difficult locations in laparoscopic liver surgery. In recent years, with the improvement in the technology and concept of laparoscopic liver surgery, the upgrading of surgical instruments and equipment and the application of three-dimensional visualization technology have made it possible to remove liver tumors in difficult locations under laparoscopy. With reference to the authors’ own experience, this article summarizes the key technical points of laparoscopic liver surgery in difficult locations, including adequate preoperative assessment, reasonable surgical planning, full exposure of surgical field through body position and trocar distribution, and prediction and prevention of the risk of bleeding. Various new techniques can be used to precisely locate the tumor and guide the partition of liver parenchyma, and with the help of a well-trained surgical anesthesia team, it is possible to ensure the safety and effectiveness of laparoscopic hepatectomy in difficult locations.
【关键字】:肝肿瘤; 肝切除术; 内窥镜检查
【Key words】:liver neoplasms; hepatectomy; endoscopy
【引证本文】:ZHANG ZL, YUAN YF. Key operating points of laparoscopic hepatectomy for liver tumor in difficult locations[J]. J Clin Hepatol, 2020, 36(12): 2663-2666. (in Chinese)
张中林, 袁玉峰. 困难部位肝肿瘤腹腔镜肝切除手术要点[J]. 临床肝胆病杂志, 2020, 36(12): 2663-2666.

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