摘要
肝切除术是目前肝癌病人获得长期生存的主要手段。但由于我国肝癌病人大多合并乙肝病毒感染和存在肝硬化背景,以及肝脏复杂的血管和胆道解剖结构,这些因素依然影响肝癌肝切除的安全性和远期疗效。除个体所患肝癌的分期、部位和侵袭性不同,有效提高手术切除质量是进一步提高肝癌疗效的重要因素。术前联合多种肝功能检测技术和现代影像学准确评估病人肝脏储备功能,以及不同肝切除方式对肝脏代偿能力的影响,以制定个体化治疗方案。术中和术后应遵循精准医疗和损伤控制原则,选择合适的麻醉方式、手术入路、肝切除范围、肝门阻断方式和断肝设备,充分考虑术后加速康复手段,为获得良好的近期和远期疗效奠定基础。术后辅以合适的综合治疗以巩固外科疗效。
Liver resection remains the major option for achieving a long-term survival in patients with primary liver cancer. However, the high relevance of HBV infection and cirrhosis in our country and the complex in intrahepatic vascular and biliary anatomy seriously and adversely affect the safety and long-term efficacy of surgical resection. How to effectively optimize the quality of surgical resection is still recognized to he important for further improving surgical effectiveness, in addition to the tumor stage, morphology and invasive nature of individual patient. Therefore, a careful preoperative evaluation should be made based on the precisely tested, liver functional reserve, provided by a variety of functional tests and integrated imaging studies. Intra- and postoperative management should follow the principle of precision liver resection and damage control, through selecting appropriate anesthesia method, surgical approach, type and extent of liver resection, portal blocking methods and sugical equipments. The enhanced recovery after surgery is also recommended for suitable patients. In addition, the proper adjuvant procedures contribute a better surgical result.
出处
《中国实用外科杂志》
CSCD
北大核心
2016年第1期11-14,共4页
Chinese Journal of Practical Surgery
基金
国家传染病重大专项课题(No.2012ZX10002016)
关键词
原发性肝癌
肝切除术
手术质量
primary liver cance
hepatectomy
surgery quality
