术中影像引导在腹腔镜和机器人肝切除术中的应用

摘要

Laparoscopic and robotic hepatectomies have proved to be safe and feasible with advantages of minimally invasive and enhanced recovery,despite the inherent defects of restricted endoscopic angle of vision and having no tactile sensing.In recent years,the development of intraoperative image-guided techniques,such as real-time intraoperative ultrasonography,intraoperative CT/MRI-guided navigation system,fusion ICG fluorescence imaging,and augmented reality,have greatly assisted surgeons with precise targeting of the tumors,preoperative surgical planning,along with supervision and in-time revision of the amputation plane of hepatic papernchyma.Therefore,it has enabled precise hepatectomy without damaging important vascular structures,reduced intraoperative blood loss,and increased the safety of surgical procedures.Besides,intraoperative image guide could compensate the defect of restricted vision in laparoscopic and robotic hepatectomies,pushing the limits of human vision field.This article will describes the application of imageguided techniques in laparoscopic and robotic hepatectomies.%腹腔镜及机器人肝切除术已被证实是安全可行的.该法具有创伤小、恢复快等优点,但也存在缺少人手触觉感知、内窥镜视野及视角受限等缺陷.近年来随着术中超声、CT或MRI影像导航、吲哚菁绿荧光融合影像引导、虚拟现实、增强现实等技术的应用,外科医生可以将复杂的肝脏解剖结构可视化、三维化,并在术中精确定位肿瘤、设计手术方案、监控并及时修正肝实质离断平面、进行精准肝切除术.术中影像引导可以避免损伤重要管道结构,减少出血,增加了手术的安全性.其在腹腔镜及机器人肝切除术中的应用不仅在一定程度上弥补了触觉和视野的缺陷,而且突破了人类视觉或触觉的极限.本文系统介绍了各种术中影像引导技术在腹腔镜及机器人肝切除术中应用.