Recent advances in techniques of liver resection.
Recent advances in techniques of liver resection.
复制标题
肝切除技术的最新进展。
DOI：
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发表时间：
2004
影响因子：
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通讯作者：
R. Poon
中科院分区：
文献类型：
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作者：
R. Poon
近年来，由于更好的患者选择，改进的手术技术和更好的围手术期管理，手术死亡率显着降低，肝切除术在良性和恶性肝胆疾病中的作用正在扩大。肝切除术的主要技术挑战是在肝实质横断过程中控制出血。超声刀和钳夹是肝横断中最常用的两种技术。近年来，已经开发了用于肝横断的新器械，目的是减少出血。肝脏手术中有助于改善围手术期结局的其他重要进展包括术中超声（IOUS）、血管吻合器的使用以及通过开发低中心静脉压麻醉减少出血。腹腔镜检查对于分期是有用的，并且由于新的腹腔镜肝脏横断器械的可用性，腹腔镜肝脏切除术越来越受欢迎。肝肿瘤局部消融治疗的发展，如射频（RF）消融，对肝切除术构成了竞争。然而，这种技术也允许将肝切除术的适应症扩展到双叶肿瘤患者，并且热消融技术已用于肝横断。本章回顾了目前的肝切除技术。
The role of liver resection for benign and malignant hepatobiliary diseases is expanding because of the markedly reduced operative mortality in recent years, as the result of better patient selection, improved surgical techniques, and better perioperative management. The major technical challenge of liver resection is control of bleeding during transection of liver parenchyma. Ultrasonic dissector and clamp crushing are the two techniques used most frequently in liver transection. In recent years, new instruments have been developed for liver transection with an aim to reduce bleeding. Other important advances in liver surgery that have contributed to improved perioperative outcomes include intraoperative ultrasound (IOUS), use of vascular staplers, and reduced bleeding by the development of low central venous pressure anesthesia. Laparoscopy is useful for staging purposes, and laparoscopic liver resection is gaining popularity due to the availability of new laparoscopic instruments for liver transection. Development of local ablative therapies for liver tumors, such as radiofrequency (RF) ablation, is posing a competition to liver resection. However, such techniques also have allowed expansion of indication for hepatic resection to patients with bilobar tumors, and thermal ablative technologies have been used for liver transection. This chapter reviews the current techniques of liver resection.