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中华腔镜外科杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 56 -59. doi: 10.3877/cma.j.issn.1674-6899.2026.01.011

综述

腹腔镜肝移植混合手术的关键技术应用现状与进展
朱轩逸1, 赵一腾1, 刘连新2, 朱泽斌3, 张树庚3,()   
  1. 1233000 蚌埠医科大学研究生院
    2230000 合肥,中国科学技术大学第一附属医院肝胆外科
    3230000 合肥,中国科学技术大学第一附属医院肝移植科
  • 收稿日期:2026-01-30 出版日期:2026-02-28
  • 通信作者: 张树庚
  • 基金资助:
    安徽省高校杰出青年科研项目(2022AH020077)

Current status and advances in key technologies of hybrid laparoscopic liver transplantation

Xuanyi Zhu1, Yiteng Zhao1, Lianxin Liu2, Zebin Zhu3, Shugeng Zhang3,()   

  1. 1Graduate School, Bengbu Medical University, Bengbu 233000, China
    2Department of Hepatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei 230000, China
    3Department of Liver Transplantation, The First Affiliated Hospital of University of Science and Technology of China (USTC); Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, China
  • Received:2026-01-30 Published:2026-02-28
  • Corresponding author: Shugeng Zhang
引用本文:

朱轩逸, 赵一腾, 刘连新, 朱泽斌, 张树庚. 腹腔镜肝移植混合手术的关键技术应用现状与进展[J/OL]. 中华腔镜外科杂志(电子版), 2026, 19(01): 56-59.

Xuanyi Zhu, Yiteng Zhao, Lianxin Liu, Zebin Zhu, Shugeng Zhang. Current status and advances in key technologies of hybrid laparoscopic liver transplantation[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(01): 56-59.

全腹腔镜肝移植受限于血管吻合的高难度与长学习曲线,临床普及尚存壁垒。混合肝移植(hybrid procedure)采取"腹腔镜下病肝游离+小切口直视下血管重建"策略,兼顾微创优势与手术安全性。本文回顾国内外临床实践,阐述该术式的解剖学基础,归纳早期预分离、ICG荧光导航等核心技术要点,并评估其临床疗效;同时,探讨其在学习曲线克服、适应证拓展(如机器人辅助)及卫生经济学层面的争议。现有证据证实,该术式在确保肿瘤学疗效的前提下,能显著缩短热缺血时间、减轻手术创伤,是现阶段微创肝移植的重要过渡与补充术式。

The clinical application of pure laparoscopic liver transplantation is currently hindered by the technical complexity of vascular reconstruction and a steep learning curve. The hybrid procedure, integrating laparoscopic mobilization of the diseased liver with vascular reconstruction via a mini-laparotomy, effectively bridges the gap between minimally invasive benefits and operative safety. This article reviews current clinical practices, elaborating on anatomical foundations and key technical strategies, including early pre-dissection and indocyanine green (ICG) fluorescence navigation. Furthermore, it addresses controversies regarding the learning curve, indication expansion (e.g., robotic assistance), and health economics. Current evidence confirms that the hybrid approach significantly shortens warm ischemia time and reduces surgical trauma while ensuring oncological safety, representing a crucial transitional and supplementary modality in the era of minimally invasive liver transplantation.

图1 腹腔镜肝移植混合手术分段式操作策略示意图注:A.第一阶段(腹腔镜期)。利用多孔腹腔镜器械进行病肝的精细游离。图中展示了"早期预分离"策略,即在腹腔镜视野下预先解剖并悬吊第一肝门(门静脉)及第二肝门(肝静脉/下腔静脉),为后续切除做准备;B.第二阶段(开放期)。通过上腹部正中或肋缘下小切口,在直视下进行部分供肝的植入与精细血管吻合。此阶段利用开放视野确切处理流出道与流入道,此时切除区病肝已移除(虚化显示)
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