机器人肝门部胆管癌根治术的优势、挑战及优化策略

Advantages, challenges, and optimization strategies of robotic radical resection for perihilar cholangiocarcinoma

摘要:

肝门部胆管癌（PHCC）起病隐匿，具有高侵袭性且预后差，根治性手术切除对患者生存意义重大。因肝门部解剖结构复杂，传统腹腔镜手术面临诸多挑战。近年来，机器人手术凭借裸眼高清3D视野、精准操作及高灵活性，在PHCC手术中应用前景显著。但该技术存在费用高昂、术中操作空间受限及缺乏触觉反馈等问题，推广应用受限。本文结合国内外研究进展及本中心实践经验，分析肿瘤局部累及范围评估、Trocar合理布局、淋巴组织与神经丛廓清、肝切除范围的判定、血管切除与重建、胆管整形及胆肠吻合等优化策略，旨在探讨如何破解上述挑战、突破现有局限，为PHCC精准微创治疗提供新策略与技术路径。

Abstract:

Perihilar cholangiocarcinoma (PHCC) has an insidious onset, is highly aggressive, and carries a poor prognosis. Radical surgical resection is crucial for improving patient survival. Due to the complex anatomy of the hepatic hilum, conventional laparoscopic surgery faces numerous challenges. In recent years, robotic surgery has shown significant potential in PHCC procedures, owing to its high-definition naked-eye 3D visualization, precise maneuvers, and superior dexterity. However, its widespread adoption remains limited by high costs, restricted intraoperative working space, and the absence of tactile feedback. Drawing on international research progress and our own clinical experience, this article analyzes optimization strategies including assessment of local tumor involvement, rational trocar placement, lymphatic and neural plexus dissection, determination of the extent of hepatectomy, vascular resection and reconstruction, bile duct reconstruction, and choledochojejunostomy. The aim is to explore approaches to overcoming these challenges and breaking through existing limitations, thereby providing new strategies and technical pathways for precise minimally invasive treatment of PHCC.