跨越肝细胞癌腹腔镜肝脏手术的界限

手术技术和围手术期管理的最新进展通过纳入患有更晚期疾病的患者，重新定义了腹腔镜肝切除术 (LLR) 的实际前沿。 尽管如此，由于潜在的肝脏疾病和技术难度，肝细胞癌 (HCC) 的 LLR 仍然被认为是一项具有挑战性的手术。 肝硬化患者、后上节段、巨大和多发性肿瘤以及重复切除术中的 LLR 存在特殊问题。 本综述侧重于这种方法在 HCC 患者中的具体局限性，以便将所有术前和术中预防措施付诸实践以克服这些局限性，使该技术成为大容量肝胆中心的护理标准。

与其他外科领域相比，肝细胞癌 (HCC) 的微创方法扩散速度较慢，这主要是由于无法控制的出血风险、肿瘤学不足以及需要腹腔镜和肝脏专业技能等固有的特殊性。 最近，腹腔镜肝切除术 (LLR) 与术后过程改善相关，包括减少术后失代偿、术中失血、住院时间长短和肿瘤学结果未改变，导致其在国际指南中得到采用。 然而，HCC 的 LLR 仍然面临一些限制，主要与底层实质功能受损、肿瘤大小和数量以及肿瘤位置困难有关。 这篇综述的目的是强调 LLR 用于 HCC 的最新技术和未来前景，重点关注克服电流限制和突破微创肝脏手术 (MILS) 界限的关键点。


腹腔镜肝细胞尾状叶切除术。 (A) 带动脉冲洗的 CT 扫描。 (B) 病灶的 ICG 增强，确保负切缘。 (C) 实质横断面。 (D) 保护 spigelian 血管。


腹腔镜右后部切除术。 (A) 带端冲洗的 CT 扫描。 (B) 右叶操作。 (C) 右后门静脉分支的选择性结扎。 (D) 使用超声空化管进行实质横断。

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