發(fā)布時(shí)間：2018-07-04 19:29

  本文選題：腹腔鏡 + 肝切除術(shù)�。� 參考：《中國實(shí)用外科雜志》2017年05期

【摘要】：近20年,腹腔鏡肝切除術(shù)在全球范圍內(nèi)廣泛開展,并在肝臟外科中占據(jù)了重要位置,但地區(qū)差異性較為顯著,且尚存在一些爭(zhēng)議。各指南對(duì)于腹腔鏡肝切除術(shù)的手術(shù)分類趨于一致,但在術(shù)式命名上,國內(nèi)指南更強(qiáng)調(diào)符合肝臟解剖學(xué)特點(diǎn),而國外指南則更側(cè)重于肝切除的范圍和難度。在適應(yīng)證具體選擇上爭(zhēng)議較多,主要是由于對(duì)技術(shù)難度的掌握與風(fēng)險(xiǎn)認(rèn)識(shí)存在分歧與差距,但各指南均指出應(yīng)謹(jǐn)慎擴(kuò)大腹腔鏡肝切除術(shù)的適應(yīng)證。在器械的選擇與設(shè)備方面,建議術(shù)者應(yīng)根據(jù)病人的情況、自身的經(jīng)驗(yàn)及所在醫(yī)療機(jī)構(gòu)的設(shè)施靈活掌握,而術(shù)中超聲則應(yīng)是腹腔鏡肝切除術(shù)的必備影像設(shè)備。在術(shù)中操作要點(diǎn)方面,各指南均強(qiáng)調(diào)術(shù)者的經(jīng)驗(yàn)與技能的重要性,而控制出血是腹腔鏡肝切除成功的關(guān)鍵,及時(shí)中轉(zhuǎn)開腹對(duì)于難以控制的出血?jiǎng)t是明智與必須的選擇。此外,各指南均強(qiáng)調(diào)專業(yè)培訓(xùn)的重要性和漸進(jìn)性,最重要的是保證病人安全。
[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.
【作者單位】： 中國醫(yī)科大學(xué)附屬盛京醫(yī)院肝膽脾外科;
【分類號(hào)】：R657.3

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