Abstract:

Interpretation and comparison of guidelines for laparoscopic liver resection from China and abroad                   DAI Chao-liu, ZHAO Chuang, XU Feng. Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University,Shenyang 110004,China
Corresponding author: DAI Chao-liu, E-mail:278170678@qq.com
Abstract    Laparoscopic liver resection (LLR) has been progressively developed worldwide along the past two decades,and takes important position on hepatic surgery.But there are remarkable geographical variances,and some aspects are still in debate. The classification of LLR is beginning to converge. Our domestic guidline highlights that the operation designation of LLR should consist with the anatomy of liver, whereas the foreign guidelines highlight the scope and difficulty of hepatectomy. Although there are a lot of controversies in the choice of indication, the guidelines recommend that we should expand the indications for LLR prudently. On the devices and equipment, the surgeon should master them thoroughly according to the patient's situation, their own experience and the facilities of medical institutions，but the intraoperative ultrasound should be the necessary equipment for LLR. On the techniques and procedures during operation, the surgeon should pay more attention to the basic operational skills to control hepatic bleeding; and timely conversion to open laparotomy for uncontrolled bleeding is a wise and necessary choose.  All the guidelines highlight the importance and gradualness of continuous surgical training. The most important is to guarantee the patient's safety.

Key words: laparoscopy, hepatectomy, guidline

摘要：

近20年，腹腔镜肝切除术在全球范围内广泛开展，并在肝脏外科中占据了重要位置，但地区差异性较为显著，且尚存在一些争议。各指南对于腹腔镜肝切除术的手术分类趋于一致，但在术式命名上，国内指南更强调符合肝脏解剖学特点，而国外指南则更侧重于肝切除的范围和难度。在适应证具体选择上争议较多，主要是由于对技术难度的掌握与风险认识存在分歧与差距，但各指南均指出应谨慎扩大腹腔镜肝切除术的适应证。在器械的选择与设备方面，建议术者应根据病人的情况、自身的经验及所在医疗机构的设施灵活掌握，而术中超声则应是腹腔镜肝切除术的必备影像设备。在术中操作要点方面，各指南均强调术者的经验与技能的重要性，而控制出血是腹腔镜肝切除成功的关键，及时中转开腹对于难以控制的出血则是明智与必须的选择。此外，各指南均强调专业培训的重要性和渐进性，最重要的是保证病人安全。

关键词: 腹腔镜, 肝切除术, 指南