腹腔镜在围肝门区肿瘤外科中的应用

刘辉; 黄长文

doi:10.3969/j.issn.1001-5256.2021.08.053

腹腔镜在围肝门区肿瘤外科中的应用

DOI: 10.3969/j.issn.1001-5256.2021.08.053

刘辉,
黄长文^,

江西省人民医院(南昌大学附属人民医院) 肝胆外科，南昌 330000

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：刘辉负责课题设计，资料分析，撰写论文；黄长文负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
黄长文，ncdxhcw@163.com

中图分类号: R735.8
计量
- 文章访问数: 426
- HTML全文浏览量: 84
- PDF下载量: 25
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-04
- 录用日期: 2021-02-25
- 出版日期: 2021-08-20

Application of laparoscopy in perihilar tumor surgery

Hui LIU,
Changwen HUANG^,

Department of Hepatobiliary Surgery, Jiangxi Provincial People's Hospital & People's Hospital Affiliated to Nanchang University, Nanchang 330000, China

摘要

摘要: 随着微创理念的推广，腹腔镜手术在肝胆外科的应用逐渐成为一种主流技术。但对于围肝门区胆管肿瘤，由于肝门区结构复杂、解剖变异多等原因，关于腹腔镜技术在围肝门区肿瘤中应用的报道较少。结合目前国内外相关报道，对腹腔镜在围肝门区肿瘤外科中的应用研究进展进行介绍，分析表明腹腔镜技术在围肝门区肿瘤的手术治疗上确有一定的优势，尤其是在Bismuth Ⅰ、Ⅱ型肝门胆管癌及早期的胆囊癌的治疗中，但由于腹腔镜手术对术者的要求较高，目前仅少数中心的专家能开展此项手术，对于手术患者也需要严格的筛选和评估，因此腹腔镜技术应用于围肝门区肿瘤外科尚处于初步探索阶段，还需要进一步的探索和学习。
- 腹腔镜 /
- 胆道肿瘤 /
- 诊断
Abstract: With the promotion of the concept of minimally invasive surgery, hepatobiliary surgery has gradually become a mainstream technique; however, for bile duct tumors in the perihilar region, there are few reports on the application of laparoscopy in such tumor due to the complex structure and anatomical variations of the hepatic hilar region. With reference to related reports in China and globally, this article introduces the research advances in the application of laparoscopy in perihilar tumor surgery. The analysis shows that laparoscopy has certain advantages in the surgical treatment of perihilar tumors, especially in the treatment of Bismuth Ⅰ/Ⅱ hilar cholangiocarcinoma and early-stage gallbladder cancer; due to the high requirements of laparoscopic surgery for the surgeon, only a few experts can perform this surgery at present, and strict screening and evaluation of patients are also required. Therefore, laparoscopy used in perihilar tumor surgery is still at the preliminary stage of exploration, with a need for further exploration and learning.
- Laparoscopes /
- Biliary Tract Neoplasms /
- Diagnosis

HTML全文

参考文献(45)

[1]	HUANG ZQ, HUANG XQ, ZHOU NX. Perihilar surgery: Concept and practice[J]. Chin J Dig Surg, 2002, 1(3): 153-159. DOI: 10.3760/cma.j.issn.1673-9752.2002.03.001. 黄志强, 黄晓强, 周宁新. 围肝门外科: 概念与实践[J]. 消化外科, 2002, 1(3): 153-159. DOI: 10.3760/cma.j.issn.1673-9752.2002.03.001.
[2]	DONG JH, YANG SZ, FENG XB. On perihilar surgery[J]. Chin J Pract Surg, 2019, 39(2): 110-112. DOI: 10.19538/j.cjps.issn1005-2208.2019.02.02. 董家鸿, 杨世忠, 冯晓彬. 论围肝门外科[J]. 中国实用外科杂志, 2019, 39(2): 110-112. DOI: 10.19538/j.cjps.issn1005-2208.2019.02.02.
[3]	HU HJ, WU ZR, JIN YW, et al. Minimally invasive surgery for hilar cholangiocarcinoma: State of art and future perspectives[J]. ANZ J Surg, 2019, 89(5): 476-480. DOI: 10.1111/ans.14765.
[4]	BOUDJEMA K, SULPICE L, GARNIER S, et al. A simple system to predict perihilar cholangiocarcinoma resectability[J]. J Gastrointest Surg, 2013, 17(7): 1247-1256. DOI: 10.1007/s11605-013-2215-4.
[5]	COELEN RJ, RUYS AT, BESSELINK MG, et al. Diagnostic accuracy of staging laparoscopy for detecting metastasized or locally advanced perihilar cholangiocarcinoma: A systematic review and meta-analysis[J]. Surg Endosc, 2016, 30(10): 4163-4173. DOI: 10.1007/s00464-016-4788-y.
[6]	GODHI SA, NADI PR, SALUJA S, et al. "Minimally invasive versus open pancreaticoduodenectomy for cancer. Practice patterns and short-term outcomes among 7061 patients"[J]. Ann Surg, 2017, 266(2): e26. DOI: 10.1097/SLA.0000000000001315.
[7]	XU J, XIONG YF, HUANG XJ, et al. A multicenter clinical analysis of short-term efficacy of laparoscopic radical resection of hilar cholangiocarcinoma[J]. Chin J Surg, 2020, 58(10): 758-764. DOI: 10.3760/cma.j.cn112139-20200210-00074. 徐建, 熊永福, 黄徐建, 等. 腹腔镜肝门部胆管癌根治性切除近期疗效的多中心临床研究[J]. 中华外科杂志, 2020, 58(10): 758-764. DOI: 10.3760/cma.j.cn112139-20200210-00074.
[8]	ZHANG Y, DOU C, WU W, et al. Total laparoscopic versus open radical resection for hilar cholangiocarcinoma[J]. Surg Endosc, 2020, 34(10): 4382-4387. DOI: 10.1007/s00464-019-07211-0.
[9]	FENG F, CAO X, LIU X, et al. Laparoscopic resection for Bismuth type Ⅲ and IV hilar cholangiocarcinoma: How to improve the radicality without direct palpation[J]. J Surg Oncol, 2019, 120(8): 1379-1385. DOI: 10.1002/jso.25739.
[10]	XU J, ZHANG W, WU CK, et al. Clinical effect of laparoscopic radical resection in treatment of type Ⅳ hilar cholangiocarcinoma[J]. J Clin Hepatol, 2019, 35(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2019.03.022. 徐建, 张薇, 邬长康, 等. 腹腔镜下根治性切除术治疗Ⅳ型肝门部胆管癌的效果分析[J]. 临床肝胆病杂志, 2019, 35(3): 565-569. DOI: 10.3969/j.issn.1001-5256.2019.03.022.
[11]	DU YS, ZHAO WX, WANG J, et al. Total laparoscopic radical resection in treatment of hilar cholangiocarcinoma (report of 6 cases)[J]. Chin J Basis Clin Gen Surg, 2017, 24(12): 1487-1491. DOI: 10.7507/1007-9424.201706139. 杜羽升, 赵文星, 王骥, 等. 完全腹腔镜手术治疗肝门部胆管癌(附6例报道)[J]. 中国普外基础与临床杂志, 2017, 24(12): 1487-1491. DOI: 10.7507/1007-9424.201706139.
[12]	JIANG WX, ZHOU L, HU YJ. Comparison of different surgical procedures for Bismuth-hilar cholangiocarcinoma[J/CD]. Chin J Oper Proc Gen Surg (Electronic Version), 2020, 14(1): 78-80. DOI: 10.3877/cma.j.issn.1674-3946.2020.01.023. 蒋维香, 周棱, 胡雅娇. Bismuth-Ⅰ型肝门胆管癌不同手术方案疗效对比[J/CD]. 中华普外科手术学杂志(电子版), 2020, 14(1): 78-80. DOI: 10.3877/cma.j.issn.1674-3946.2020.01.023.
[13]	DUAN C, ZHU QS, WANG MZ, et al. Comparison of different surgical procedures for Bismuth-hilar cholangiocarcinoma[J/CD]. Chin J Oper Proc Gen Surg (Electronic Version), 2019, 13(6): 552-555. DOI: 10.3877/cma.j.issn.1674-3946.2019.06.005. 段畅, 朱求实, 王满贞, 等. 两种手术方法在Bismuth Ⅰ型肝门胆管癌根治术的临床疗效研究[J/CD]. 中华普外科手术学杂志(电子版), 2019, 13(6): 552-555. DOI: 10.3877/cma.j.issn.1674-3946.2019.06.005.
[14]	CAI HH, HU ZM, LIU J, et al. Initial experience of total laparoscopic radical resection for Bismuth type Ⅲ a hilar cholangiocarcinoma: A report of three cases[J]. Chin J Hepatobiliary Surg, 2018, 24(9): 613-615. DOI: 10.3760/cma.j.issn.1007-8118.2018.09.010. 蔡涵晖, 胡智明, 刘杰, 等. 完全腹腔镜下Bismuth Ⅲa型肝门部胆管癌根治术三例[J]. 中华肝胆外科杂志, 2018, 24(9): 613-615. DOI: 10.3760/cma.j.issn.1007-8118.2018.09.010.
[15]	BHUTIANI N, SCOGGINS CR, MCMASTERS KM, et al. The impact of caudate lobe resection on margin status and outcomes in patients with hilar cholangiocarcinoma: A multi-institutional analysis from the US extrahepatic biliary malignancy consortium[J]. Surgery, 2018, 163(4): 726-731. DOI: 10.1016/j.surg.2017.10.028.
[16]	ZHANG CW, LIU J, HONG DF, et al. Pure laparoscopic radical resection for type Ⅲa hilar cholangiocarcinoma[J]. Surg Endosc, 2018, 32(3): 1581-1582. DOI: 10.1007/s00464-017-5741-4.
[17]	LI SM, ZHANG XM, HUANG CW, et al. Comparison of different surgical procedures for Bismuth-hilar cholangiocarcinoma[J]. Chin J Oper Proc Gen Surg, 2019, 34(8): 714-715. DOI: 10.3760/cma.j.issn.1007-631X.2019.08.019. 李师淼, 张晓明, 黄长文, 等. 腹腔镜Bismuth Ⅳ型肝门部胆管癌根治术的分析[J]. 中华普通外科杂志, 2019, 34(8): 714-715. DOI: 10.3760/cma.j.issn.1007-631X.2019.08.019.
[18]	ZHANG J, GUO X, WANG H, et al. The application of three-dimensional visualization in preoperative evaluation of portal vein invasion in hilar cholangiocarcinoma[J]. Cancer Manag Res, 2020, 12: 9297-9302. DOI: 10.2147/CMAR.S264479.
[19]	Expert Group on Operational Norms of Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma; Editorial Board of Chinese Journal of Surgery. Expert recommendation for operational norms of laparoscopic radical resection of perihilar cholangiocarcinoma[J]. Chin J Surg, 2019, 57(8): 561-567. DOI: 10.3760/cma.j.issn.0529-5815.2019.08.001. 腹腔镜肝门部胆管癌根治切除术操作规范专家组, 《中华外科杂志》编辑部. 腹腔镜肝门部胆管癌根治性切除操作流程专家建议[J]. 中华外科杂志, 2019, 57(8): 561-567. DOI: 10.3760/cma.j.issn.0529-5815.2019.08.001.
[20]	HE M, WANG HL, YAN JH, et al. The safety and effect of transhepatic hilar approach for the treatment of bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma[J]. Chin J Surg, 2018, 56(5): 360-366. DOI: 10.3760/cma.j.issn.0529-5815.2018.05.008. 何敏, 王昊陆, 闫加艳, 等. 顺逆结合肝中裂劈开肝门显露法治疗Bismuth Ⅲ、Ⅳ型肝门胆管癌的安全性与疗效分析[J]. 中华外科杂志, 2018, 56(5): 360-366. DOI: 10.3760/cma.j.issn.0529-5815.2018.05.008.
[21]	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
[22]	HAN HS, YOON YS, AGARWAL AK, et al. Laparoscopic surgery for gallbladder cancer: An expert consensus statement[J]. Dig Surg, 2019, 36(1): 1-6. DOI: 10.1159/000486207.
[23]	SØREIDE K, GUEST RV, HARRISON EM, et al. Systematic review of management of incidental gallbladder cancer after cholecystectomy[J]. Br J Surg, 2019, 106(1): 32-45. DOI: 10.1002/bjs.11035.
[24]	LUNDBERG O, KRISTOFFERSSON A. Open versus laparoscopic cholecystectomy for gallbladder carcinoma[J]. J Hepatobiliary Pancreat Surg, 2001, 8(6): 525-529. DOI: 10.1007/s005340100020.
[25]	PAOLUCCI V. Port site recurrences after laparoscopic cholecystectomy[J]. J Hepatobiliary Pancreat Surg, 2001, 8(6): 535-543. DOI: 10.1007/s005340100022.
[26]	AGARWAL AK, JAVED A, KALAYARASAN R, et al. Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: A retrospective comparative study[J]. HPB (Oxford), 2015, 17(6): 536-541. DOI: 10.1111/hpb.12406.
[27]	LIU YB, BAO RF. Present status and development of laparoscopic surgery for gallbladder cancer[J/CD]. Chin J Oper Proc Gen Surg (Electronic Version), 2020, 14(3): 217-220. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.001. 刘颖斌, 包润发. 腹腔镜胆囊癌外科治疗现状与发展[J/CD]. 中华普外科手术学杂志(电子版), 2020, 14(3): 217-220. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.001.
[28]	BENSON AB 3rd, D'ANGELICA MI, ABBOTT DE, et al. NCCN guidelines insights: Hepatobiliary cancers, version 1. 2017[J]. J Natl Compr Canc Netw, 2017, 15(5): 563-573. DOI: 10.6004/jnccn.2017.0059.
[29]	ITANO O, OSHIMA G, MINAGAWA T, et al. Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma[J]. Surg Endosc, 2015, 29(12): 3600-3607. DOI: 10.1007/s00464-015-4116-y.
[30]	FENG JW, YANG XH, LIU CW, et al. Comparison of laparoscopic and open approach in treating gallbladder cancer[J]. J Surg Res, 2019, 234: 269-276. DOI: 10.1016/j.jss.2018.09.025.
[31]	CHEN XN, SUN SB, WU DQ. Several issues of laparoscopic surgery for gallbladder cancer[J/CD]. Chin J Oper Proc Gen Surg (Electronic Version), 2020, 14(3): 228-230. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.004. 陈晓宁, 孙世波, 吴德全. 腹腔镜胆囊癌外科治疗的若干问题[J/CD]. 中华普外科手术学杂志(电子版), 2020, 14(3): 228-230. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.004.
[32]	MIYAZAKI M, YOSHITOMI H, MIYAKAWA S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: The 2nd English edition[J]. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273. DOI: 10.1002/jhbp.233.
[33]	YAN ZY, DING JJ, WANG Z. Application of laparoscopic exploration in surgical treatment of gallbladder carcinoma[J]. Chin J Gen Surg, 2017, 26(8): 1071-1075. DOI: 10.3978/j.issn.1005-6947.2017.08.017. 燕重远, 丁俊杰, 王谆. 腹腔镜探查在胆囊癌外科治疗中的应用[J]. 中国普通外科杂志, 2017, 26(8): 1071-1075. DOI: 10.3978/j.issn.1005-6947.2017.08.017.
[34]	PAN DB, YE GX, XU SQ, et al. The clinical effect comparasion between laparoscopic radical resection and open radical resection for early-stage gallbladder cancer[J]. J Hepatopancreatobiliary Surg, 2019, 31(2): 83-86. DOI: 10.11952/j.issn.1007-1954.2019.02.006. 潘德标, 叶冠雄, 徐胜前, 等. 腹腔镜根治术与开腹根治术治疗早期胆囊癌的临床疗效比较[J]. 肝胆胰外科杂志, 2019, 31(2): 83-86. DOI: 10.11952/j.issn.1007-1954.2019.02.006.
[35]	EBATA T, KAMIYA J, NISHIO H, et al. The concept of perihilar cholangiocarcinoma is valid[J]. Br J Surg, 2009, 96(8): 926-934. DOI: 10.1002/bjs.6655.
[36]	ZHANG XF, BAGANTE F, CHEN Q, et al. Perioperative and long-term outcome of intrahepatic cholangiocarcinoma involving the hepatic hilus after curative-intent resection: Comparison with peripheral intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma[J]. Surgery, 2018, 163(5): 1114-1120. DOI: 10.1016/j.surg.2018.01.001.
[37]	WANG J. Establishment of peri-hepatic portal technical system for complex biliary tract surgery[J]. J Hepatopancreatobiliary Surg, 2019, 31(2): 65-68, 75. DOI: 10.11952/j.issn.1007-1954.2019.02.001. 王坚. 创建复杂胆道外科的围肝门技术体系[J]. 肝胆胰外科杂志, 2019, 31(2): 65-68, 75. DOI: 10.11952/j.issn.1007-1954.2019.02.001.
[38]	AKITA M, SOFUE K, FUJIKURA K, et al. Histological and molecular characterization of intrahepatic bile duct cancers suggests an expanded definition of perihilar cholangiocarcinoma[J]. HPB (Oxford), 2019, 21(2): 226-234. DOI: 10.1016/j.hpb.2018.07.021
[39]	LU J, LI B, LI FY, et al. Long-term outcome and prognostic factors of intrahepatic cholangiocarcinoma involving the hepatic hilus versus hilar cholangiocarcinoma after curative-intent resection: Should they be recognized as perihilar cholangiocarcinoma or differentiated?[J]. Eur J Surg Oncol, 2019, 45(11): 2173-217. DOI: 10.1016/j.ejso.2019.06.014.
[40]	CHEN W, WANG J. Application of perihilar surgical techniques in intrahepatic cholangiocarcinoma invading hepatic hilum[J]. Chin J Pract Surg, 2019, 39(2): 134-138. DOI: 10.19538/j.cjps.issn1005-2208.2019.02.08. 陈炜, 王坚. 围肝门外科技术治疗侵犯肝门的肝内胆管癌[J]. 中国实用外科杂志, 2019, 39(2): 134-138. DOI: 10.19538/j.cjps.issn1005-2208.2019.02.08.
[41]	WEBER SM, RIBERO D, O'REILLY EM, et al. Intrahepatic cholangiocarcinoma: Expert consensus statement[J]. HPB (Oxford), 2015, 17(8): 669-680. DOI: 10.1111/hpb.12441.
[42]	LUO LP, LI JW, CAO L, et al. Clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma[J]. Chin J Dig Surg, 2019, 18(2): 169-175. DOI: 10.3760/cma.j.issn.1673-9752.2019.02.012. 罗柳平, 李建伟, 曹利, 等. 腹腔镜肝切除术治疗肝内胆管癌的临床疗效[J]. 中华消化外科杂志, 2019, 18(2): 169-175. DOI: 10.3760/cma.j.issn.1673-9752.2019.02.012.
[43]	SHIRAIWA DK, CARVALHO PFDC, MAEDA CT, et al. The role of minimally invasive hepatectomy for hilar and intrahepatic cholangiocarcinoma: A systematic review of the literature[J]. J Surg Oncol, 2020, 21(5): 863-872. DOI: 10.1002/jso.25821.
[44]	YAN JY, CHEN W, WANG J. Combined anterograde and retrograde method exposing porta hepatis for the treatment of intrahepatic cholangiocarcinoma invading porta hepatis[J]. Chin J Dig Surg, 2017, 16(4): 417-422. DOI: 10.3760/cma.j.issn.1673-9752.2017.04.019. 闫加艳, 陈炜, 王坚. 顺逆结合肝门显露法治疗侵犯肝门的肝内胆管细胞癌[J]. 中华消化外科杂志, 2017, 16(4): 417-422. DOI: 10.3760/cma.j.issn.1673-9752.2017.04.019.
[45]	CHEN YJ, CAO J. The safety and effect of transhepatic hilar approach for the treatment of bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma[J]. Chin J Pract Surg, 2020, 40(6): 673-676. DOI: 10.19538/j.cjps.issn1005-2208.2020.06.11. 陈亚进, 曹君. 腹腔镜技术在肝内胆管癌手术中应用[J]. 中国实用外科杂志, 2020, 40(6): 673-676. DOI: 10.19538/j.cjps.issn1005-2208.2020.06.11.