国内外腹腔镜肝切除术相关指南解读与比较

发布时间：2018-07-04 19:29

本文选题：腹腔镜 + 肝切除术　；参考：《中国实用外科杂志》2017年05期

【摘要】：近20年,腹腔镜肝切除术在全球范围内广泛开展,并在肝脏外科中占据了重要位置,但地区差异性较为显著,且尚存在一些争议。各指南对于腹腔镜肝切除术的手术分类趋于一致,但在术式命名上,国内指南更强调符合肝脏解剖学特点,而国外指南则更侧重于肝切除的范围和难度。在适应证具体选择上争议较多,主要是由于对技术难度的掌握与风险认识存在分歧与差距,但各指南均指出应谨慎扩大腹腔镜肝切除术的适应证。在器械的选择与设备方面,建议术者应根据病人的情况、自身的经验及所在医疗机构的设施灵活掌握,而术中超声则应是腹腔镜肝切除术的必备影像设备。在术中操作要点方面,各指南均强调术者的经验与技能的重要性,而控制出血是腹腔镜肝切除成功的关键,及时中转开腹对于难以控制的出血则是明智与必须的选择。此外,各指南均强调专业培训的重要性和渐进性,最重要的是保证病人安全。
[Abstract]:In the past 20 years, laparoscopic hepatectomy has been widely carried out in the world and occupied an important position in liver surgery. However, the regional differences are significant and there are still some controversies. The operative classification of laparoscopic hepatectomy tends to be consistent, but the domestic guidelines emphasize the characteristics of liver anatomy, while the foreign guidelines focus on the scope and difficulty of hepatectomy. There are many controversies in the selection of indications, mainly due to the differences and gaps in the understanding of technical difficulty and risk, but all the guidelines point out that the indications of laparoscopic hepatectomy should be expanded carefully. In the choice of instruments and equipment, it is suggested that the operator should be flexible in accordance with the patient's situation, their own experience and facilities in the medical institution, while intraoperative ultrasound should be the necessary imaging equipment for laparoscopic hepatectomy. All the guidelines emphasize the importance of the experience and skill of the operative, and the control of bleeding is the key to the success of laparoscopic hepatectomy, and the timely conversion to laparotomy is a wise and necessary choice for the difficult bleeding. In addition, the guidelines emphasize the importance and progressiveness of professional training and, most importantly, the safety of patients.
【作者单位】：中国医科大学附属盛京医院肝胆脾外科;
【分类号】：R657.3

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