腹腔镜和机器人辅助肝门部胆管癌R0切除的策略与方法

Strategies and methods for laparoscopic-assisted and robotic-assisted R0 resection of perihilar cholangiocarcinoma

  • 摘要: 肝门部胆管癌是一种起源于胆管上皮的恶性肿瘤。鉴于其独特的生物学特性,根治性切除术仍是目前最有效的治疗手段,患者生存率与R0切除密切相关。然而,该肿瘤具有向肝门区结构侵袭蔓延的倾向性,常需实施复杂的手术操作,导致R0切除率较低。近年来,随着腹腔镜和机器人外科技术的持续进步,国内外多个医学中心已成功开展腹腔镜和机器人辅助肝门部胆管癌根治术,甚至涵盖血管切除重建。实现R0切除仍是手术的核心目标。为此,部分医学中心开始探索应用SpyGlass DS数字单人操作胆道镜系统(SpyGlass DSOC)进行术前肿瘤胆管腔内定位;亦有研究尝试结合SpyGlass DSOC、胆管腔内超声检查、光学相干断层成像及共聚焦激光显微内镜等技术,辅助外科医师精准判断切缘距离,以期优化R0切除效果。笔者回顾既往文献,并结合团队实践经验,系统阐述腹腔镜和机器人辅助肝门部胆管癌R0切除的策略与方法。

     

    Abstract: Perihilar cholangiocarcinoma is a malignant tumor originating from the biliary tract epithelium. Due to its unique biological behavior, radical resection remains the most effective treatment currently, with patient survival rate highly correlated with R0 resection. However, perihilar cholangiocarcinoma tends to invade and spread to the hilar structures, often necessitating complex surgical procedures with low R0 resection rate. In recent years, with the continuous development of laparoscopic and robotic technology, many domestic and international centers have successfully performed laparoscopic-assisted and robotic-assisted radical resection of perihilar cholangiocarcinoma, even including vascular resection and reconstruction. R0 resection remains the essential of surgery, and some centers have begun to use the SpyGlass DS digital single‑operator cholangioscopy system for preoperative intraluminal localization of tumor in the bile duct. There are also attempts to use SpyGlass system in combination with intraductal ultrasound, optical coherence tomography, confocal laser endomicroscopy and other techniques, to assist surgeons in accurately determining the resection margins, thereby achieving better R0 resection. Based on previous literature and team experiences, the authors elaborate on the strategies and methods for laparoscopic-assisted and robotic-assisted R0 resection of perihilar cholangiocarcinoma.

     

/

返回文章
返回