在肝胆疾病的腹腔镜外科的现状与展望
Current status and future perspective of laparoscopic surgery in hepatobiliary disease
Abstract
摘要
Recent advances in minimally invasive surgery include laparoscopic and robotic surgery. These surgical techniques have changed the paradigm of surgical treatment for hepatobiliary diseases. Minimally invasive surgery has the advantages of minimal wound extension for cosmetic effect, early postoperative recovery, and few postoperative complications in patients. For laparoscopic liver resection, the indications have been expanded and oncological outcome was proven to be similar with open surgery in the malignant disease. Laparoscopic cholecystectomy is a classical operation for benign gallbladder diseases and the effort to decrease the surgical wound resulted to perform single incision laparoscopic cholecystectomy. For choledochal cyst, laparoscopic surgery is applied gradually despite of the difficulties associated with anastomosis, and robotic surgery for hepatobiliary disease is also performed for more minimally invasive surgery; however, while admitting the advantage of robotic surgery, robotic technology should be improved for development of more convenient and cheaper instrument and continuous efforts to enhance surgical technique to overcome long operation is necessary. In this review, the status and future perspectives of minimally invasive surgery for hepatobiliary diseases are summarized and discussed.
微创手术的最新进展包括腹腔镜和机器人手术。这些外科技术已经改变了对肝胆疾病的外科治疗范式。微创手术具有美容效果微创、术后早期恢复和术后并发症少等优点。腹腔镜肝切除术的指征，已扩大和肿瘤学结果被证明是与恶性疾病开腹手术相似。腹腔镜胆囊切除术是胆囊良性疾病的经典手术，是胆囊切除术减少手术切口的一种手术切口。胆总管囊肿，腹腔镜手术的应用逐渐尽管与吻合的困难，对肝胆疾病的机器人手术还进行了更多的微创手术；然而，在承认机器人手术的优点的同时，应改进机器人技术，开发更方便、更便宜的仪器，并不断努力，以提高外科手术技术，克服长时间的手术是必要的。在这篇综述中，对肝胆疾病的现状和微创手术的未来前景进行了总结和讨论。
Figure 1. (A) Laparoscopic and (B) robotic left lateral sectionectomy.
图1.（a）腹腔镜和（b）机器人肝左外叶部分切除术。
Figure 2. (A) Three-port laparoscopic cholecystectomy (LC), (B) robotic cholecystectomy, and (C) single-incision LC. (D) The limited angle of instruments and fulcrum effect in single-incision LC. Consideration of the angle avoiding the fighting of instrument and use of angulated instrument facilitate safe single-incision LC.
图2.(A) 三孔腹腔镜胆囊切除术（LC）、（B）机器人胆囊切除术，和（C）单切口腹腔镜胆囊切除术。（D）单切口腹腔镜胆囊切除手术器械的限制角度及支点效应。考虑的角度，对避免仪器活动度的思考和使用方便安全角度仪单切口腹腔镜胆囊切除术。
Figure 3. Laparosopic excision of (A) choledochal cyst and (B) hepaticojejunostomy. Robotic-assisted excision of (C) choledochal cyst and (D) hepaticojejunostomy.
图3.腹腔镜切除术（A）胆总管囊肿和（B）肝管空肠吻合术。机器人辅助手术（c）胆总管囊肿和（d）肝管空肠吻合术。
原文：
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