微创外科技术在肝门部胆管癌根治术中的现状与思考

Current status and pondering of minimally‑invasive surgical techniques in radical resection of hilar cholangiocarcinoma

  • 摘要: 肝门部胆管癌是一种治疗极为困难、预后差的胆道恶性肿瘤,根治性手术切除是其唯一有希望达到治愈的手段。近年来,随着腹腔镜、机器人手术系统等微创手术技术的不断发展与成熟,国内外已有少数大型医学中心尝试采用腹腔镜或机器人手术系统实施微创肝门部胆管癌根治术。腹腔镜或机器人辅助肝门部胆管癌根治术目前在技术上安全、可行,但尚缺乏大宗病例报道及对患者远期生存的评估。笔者回顾既往文献,结合团队开展腹腔镜肝胆胰手术、机器人辅助肝门部胆管癌根治术的经验,详细阐述腹腔镜、机器人手术系统在肝门部胆管癌根治术的应用现状,并就开展该技术需要注意的关键问题如术者应具备条件与患者选择、如何确保手术根治性、提高远期疗效等方面进行探讨。

     

    Abstract: Hilar cholangiocarcinoma is one difficultly‑treated biliary malignancy with poor prognosis, and radical resection offers the only hope of cure for the disease. In recent years, with development and maturation of minimally‑invasive techniques, laparoscopic or robotic‑assisted radical resection of hilar cholangiocarcinoma has been attempted in some major medical centers. Laparoscopic and robotic‑assisted radical resection of hilar cholangiocarcinoma is technically safe and feasible at present, but there is still a lack of large number of case report and evaluation of long-term survival of patients. Based on previous literatures and combined with clinical experiences, the author elaborates on the application status of laparoscopic and robot surgical system in the radical resection of hilar cholangiocarcinoma, and discusses the key issues that should be paid attention to in carrying out this technology, such as the operator′s prerequisite requirement and patients′ selec-tion, how to ensure the radicality of surgical resection and improve the long‑term outcomes.

     

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