近年来腹腔镜肝切除术技术发展迅速.随着影像学的发展、手术适应证的不断扩大、手术器械不断进步、手术流程的逐渐规范化,越来越多的小肝癌患者接受了腹腔镜肝切除治疗.与大肝癌相比,术中小肝癌更容易进行操作,小肝癌无疑是学习腹腔镜肝切除技术的最佳选择.但由于缺乏标准术式、术中大量出血难易控制以及术者学习周期较长等问题阻碍着这项技术的发展.本文结合实践体会,从病人的选择、肝脏肿瘤识别及定位、肝门血流阻断、控制性低中心静脉压、术野的暴露、切线及切除范围、肝实质的离断技术等方面,就腹腔镜肝切除术治疗小肝癌的难点及关键技术进行讨论.
In recent years, laparoscopichepatectomy has been developing rapidly . With the development ofmedical imaging, surgical indications continue to expand ,surgical instruments continue to sophisticated, gradually standardized surgical procedures , more and more patients with small hepatocellular carcinoma underwent laparoscopic hepatectomy . Compared with large hepatocellular carcinoma , smallhepatocellular carcinoma is easier to operate, small hepatocellular carcinoma is undoubtedly the choice of laparoscopichepatectomy However , due to the lack of standard surgical procedures , uncontrollableintraoperative bleeding, long learning cycle or other issues hinder the development of this technology.Based on our experience, patient selection,recognition and localization of tumor , hepatic portal blockade,controlled low central venous pressure , surgical field exposure,correct resection plane, echniques of liver parenchymal transectionfor small hepatocellular are the difficult steps and key technologiesof successful laparoscopic hepatectomyfor small liver cancer .