摘要
肝切除是肝脏肿瘤最重要的根治性手段,其发展经历了局部切除、不规则切除、规则切除、解剖性切除等理念.随着对解剖认识的加深、肝实质离断器械的进步以及控制性低中心静脉压策略等的实施,无论开放还是微创肝切除均得到极大的普及与发展.在精准外科理念指导下,解剖性肝切除越来越受到重视,但关于手术方式选择解剖性还是非解剖性肝切除一直存在争议.临床中应综合评估肿瘤位置、大小、生物学行为和肝脏功能,兼顾手术安全性与彻底性,并要考虑到术后肿瘤复发和后续治疗,以患者获益最大化作为手术方式选择的依据.本文综述了国内外已发表文献,对肝细胞癌解剖性肝切除的规范与研究进展进行回顾与讨论.
Abstract
Hepatectomy is the most important curative treatment for liver neoplasms,and its deve-lopment has experienced such concepts as local resection,irregular resection,regular resection and anatomic resection.With the enhanced understanding of hepatic anatomy,the progression of hepatic parenchymal dis-section devices and the implementation of controlled low central venous pressure strategies,both open and minimally invasive hepatectomy have gained great popularity and development.Under the guidance of the concept of precision surgery,anatomic resection has garnered increasing attention,yet a contentious debate persists regarding the selection between anatomic and non-anatomic liver resection.In clinical practice,it is imperative to conduct a comprehensive evaluation of the tumor's location,size,biological characteristics,and hepatic function.This evaluation should consider the safety and thoroughness of the surgical procedure,as well as the potential for tumor recurrence and the subsequent follow-up treatment.Ultimately,the selection of surgical methods should be based on maximizing the patient's benefits.This paper reviews and discusses the published literatures,both domestic and abroad,on the norms and research progress of anatomic liver resection for hepatocellular carcinoma.
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