Pan M, Zhang C
Second Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2022 Jan 20;42(1):156-162. doi: 10.12122/j.issn.1673-4254.2022.01.20.
With the development and application of laparoscopic hepatectomy in major medical centers, domestic and foreign guidelines have summarized the indications, surgical techniques and operational procedures of the surgery. But in primary care facilities, where the surgical equipment are available, laparoscopic hepatectomy is performed only in a small number of cases and the progress of its application remains slow. The reasons possibly lie in the failure of a full understanding of the surgery, the lack of anatomical knowledge of laparoscopic hepatectomy, the lack of close multidisciplinary cooperation in the perioperative period and insufficient training of laparoscopic technology. In this review, we elaborate on three aspects of laparoscopic hepatectomy: preoperative planning, surgical techniques and postoperative management. Before the operation, the surgeons should fully understand the anatomical structure of the liver and select appropriate cases considering both the difficulty of operation and the surgical experience of the surgeons. During the operation, the position of the patient and the layout of the stamping card should be appropriate, and the central venous pressure needs to be well controlled in close cooperation with the anesthesiologist. The surgeons should be proficient at the techniques of liver suspension and pulling and at the use of ultrasonic knife, and select correct techniques for management of bleeding and the control of blood flow in and out of the liver. The patient should receive postoperative management with standard enhanced recovery after surgery (ERAS) protocols. These experiences may help to improve the practice of laparoscopic hepatectomy in local hospitals or primary care facilities.
随着腹腔镜肝切除术在国内外各大医疗中心的发展与应用，国内外指南已总结了该手术的适应证、手术技术及操作流程。但在具备手术设备的基层医疗机构中，腹腔镜肝切除术仅在少数病例中开展，其应用进展仍然缓慢。原因可能在于对该手术缺乏全面了解、缺乏腹腔镜肝切除的解剖学知识、围手术期缺乏紧密的多学科协作以及腹腔镜技术培训不足。在本综述中，我们阐述了腹腔镜肝切除术的三个方面：术前规划、手术技术及术后管理。手术前，外科医生应充分了解肝脏的解剖结构，并结合手术难度和自身手术经验选择合适的病例。手术过程中，患者体位及戳卡布局应恰当，并需与麻醉医生密切合作，良好控制中心静脉压。外科医生应熟练掌握肝脏悬吊牵拉技术及超声刀的使用，并选择正确的出血处理及肝脏出入血流控制技术。患者术后应采用标准的加速康复外科（ERAS）方案进行管理。这些经验可能有助于改善基层医院或基层医疗机构腹腔镜肝切除术的实践。
