腹腔镜门静脉流域解剖性肝切除技术发展及要点

Development and key points of laparoscopic portal territory anatomical liver resection

摘要:

经典解剖性肝切除的发展历程颇具争议，尤其是其在治疗肝细胞癌的肿瘤学疗效上一直备受质疑。随着外科技术的不断进步和微创手术设备的持续迭代，腹腔镜门静脉流域解剖性肝切除（LPTAR）逐渐在临床上得到应用。与经典解剖性肝切除依据Couinaud分段实施的“近似肝段切除”不同，LPTAR整合了术前三维可视化及术中吲哚菁绿荧光导航等技术，立足于真实的门静脉流域肝段，其核心在于实现完整荷瘤门静脉流域的“精准肝段切除”。目前，LPTAR正处于快速发展阶段，但仍面临诸多技术挑战，如精准肝蒂的识别与控制、困难肝段的染色以及解剖变异的应对等问题。为解决这些难题，制定规范化、流程化的技术标准至关重要，这将有助于提高手术的完成度和安全性，进而带来更大的肿瘤学效益。精准肝切除一直是外科医生的不懈追求，而LPTAR引领的腹腔镜肝切除术有望在精准肝切除领域留下深刻的印记。

Abstract:

The development of classical anatomical liver resection has been a topic of considerable debate, particularly regarding its oncological efficacy in treating hepatocellular carcinoma. With continuous advancements in surgical techniques and iterative improvements in minimally invasive surgical equipment, laparoscopic portal territory anatomical resection (LPTAR) has gradually been adopted in clinical practice. Unlike classical anatomical liver resection, which approximates liver segmentectomy based on Couinaud's segmentation, LPTAR integrates technologies such as preoperative 3D visualization and intraoperative indocyanine green fluorescence navigation to target the true portal venous territory. Its core principle lies in achieving "precise liver segmentectomy" of the tumor-bearing portal venous territory. Currently, LPTAR is undergoing rapid development but faces several technical challenges, including the precise identification and control of hepatic pedicles, effective staining of difficult liver segments, and management of anatomical variations. Establishing standardized and streamlined technical protocols is crucial to addressing these issues, as it will improve surgical completeness and safety while enhancing oncological outcomes. Precision liver resection has long been a pursuit of surgeons, and laparoscopic liver resection, led by LPTAR, is poised to make a lasting impact in the field of precision hepatic surgery.