摘要
近年来,随着腹腔镜技术进步以及对肝胆管结石病临床病理特征认知的深入,尤其是精准外科、数字医学、加速康复外科等理念和技术的融入,使肝胆管结石病的腹腔镜外科治疗逐步走向规范化和精准化.目前应用腹腔镜技术治疗复杂肝胆管结石虽存在一些难点和争议问题,但总体安全、可行,具有一定疗效优势和广泛应用前景.正确选择手术适应证,全面详尽的术前评估和手术规划,以精准胆管树流域切除理念为核心,遵循规范的手术路径,掌握娴熟腹腔镜肝切除、肝门部胆管整形吻合及胆道镜取石技术,合理选择应用术中超声、吲哚菁绿(ICG)荧光染色、增强/混合现实等辅助手段是手术成功的关键.
Abstract
In recent years,with the advancement of laparoscopic technology and the in-depth understanding of the clinicopathological characteristics of hepatolithiasis,especially the integration of concepts and technologies such as precision surgery,digital medicine,and accelerated recovery surgery,the laparoscopic surgical treatment of hepatolithiasis has gradually become standardized and precise.At present,although there are some difficulties and controversies in the application of laparoscopic technology in the treatment of complex hepatolithiasis,it is generally safe and feasible,and has certain short-term advantages and wide application prospects.The key to the success of the operation is the correct selection of surgical indications,comprehensive and detailed preoperative evaluation,and surgical planning,taking the concept of precise diseased bile duct tree territory resection as the core,following the standardized surgical procedures,mastering the techniques of laparoscopic liver resection,hilar bile duct plastic-anastomosis and choledochoscopy stone removal,and reasonably selecting and applying intraoperative ultrasound,ICG fluorescence staining,augmented/mixed reality and other auxiliary technologies.
国家科技期刊平台
NSTL
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