醫(yī)學(xué)優(yōu)秀讀書(shū)報(bào)告

1、經(jīng)前入路右半肝切除術(shù),,,,,,,2017年6月在日本舉行了第六屆亞太肝膽胰學(xué)會(huì)大會(huì)（APHPBA, Asian-Pacific Hepato-panceato-biliary Association）,此次會(huì)議是亞太地區(qū)肝膽胰領(lǐng)域最大、最具影響力的學(xué)術(shù)會(huì)議。,,,,,前入路右半肝切除術(shù),什么是前入路右半肝切除術(shù),,,,,？,前入路右半肝切除術(shù),1、首先臨時(shí)阻斷門(mén)管三聯(lián)，即第一肝門(mén),2、然后邊切肝邊結(jié)扎離斷肝內(nèi)血管和膽管,3、再結(jié)扎離斷

2、右肝靜脈和肝短靜脈，即第二、第三肝門(mén),4、最后游離三角韌帶、廉狀韌帶，進(jìn)行肝切除,前入路右半肝切除術(shù),前入路右半肝切除術(shù),第一肝門(mén),第二肝門(mén),第三肝門(mén),,,,前入路右半肝切除術(shù),前入路右半肝切除術(shù),王俊剛.前入路右半肝切除術(shù)與傳統(tǒng)右半肝切除術(shù)治療大肝癌的比較[J].中國(guó)普通外科雜志,2013,23 (1):18-21.,前入路右半肝切除術(shù),,觀察組與對(duì)照組手術(shù)情況和住院時(shí)間比較（n=30),,,前入路右半肝切除術(shù),,觀察組與對(duì)照組術(shù)后并

3、發(fā)癥、病死率、復(fù)發(fā)率和生存率比較,,前入路右半肝切除術(shù),,Thinking,1、前入路右半肝切除術(shù)的 療效并沒(méi)有理論分析的 那樣好？,2、文章的質(zhì)量存在問(wèn)題？,3、樣本量不足？,4、其他,傳統(tǒng)綜述、專家經(jīng)驗(yàn)、病例報(bào)告,回顧性的病例對(duì)照研究、病例系列研究,前瞻性非隨機(jī)對(duì)照臨床試驗(yàn)或隊(duì)列研究,單個(gè)RCT,多個(gè)RCT的系統(tǒng)綜述/Meta分析,前入路右半肝切除術(shù),研究類(lèi)型的證據(jù)級(jí)別,,,前入路右半肝切除術(shù),佟慶,晏冬,毛拉艾

4、沙·買(mǎi)買(mǎi)提,等.前入路與傳統(tǒng)入路右半肝切除術(shù)治療肝癌療效的Meta 分析[J].中國(guó)普通外科雜志,2016,25 (7):957-964.,前入路右半肝切除術(shù),,研究共納入的9 篇已發(fā)表的研究，總樣本量是1344例,前入路右半肝切除術(shù),無(wú)效線,原因分析,,,,,前入路右半肝切除術(shù)屬于半肝阻斷，肝內(nèi)血管仍與下腔靜脈相連,無(wú)明確手術(shù)適應(yīng)癥，對(duì)于侵犯下腔靜脈的肝癌更容易導(dǎo)致術(shù)中出血,無(wú)統(tǒng)一的操作規(guī)范指南，而且外科醫(yī)生的技術(shù)水平參差不

5、齊,,,,前入路右半肝切除術(shù),,肝內(nèi)控制Glissonian鞘,前入路右半肝切除術(shù),通過(guò)術(shù)中降低中心靜脈壓,Belghiti提出的肝懸吊技術(shù)。,經(jīng)肝后無(wú)血管通道的陳式雙肝懸吊技術(shù)。,,,,,,,規(guī)范手術(shù)的操作步驟,多于麻醉醫(yī)生進(jìn)行學(xué)術(shù)交流,增加樣本量，得出更加可靠的結(jié)論，為臨床決策提供參考依據(jù),外科醫(yī)生不斷更新自己的臨床知識(shí)和提高手術(shù)技巧,展望,1,2,3,4,前入路右半肝切除術(shù),[1] Chen W, Zheng R, Baade P

6、D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132.[2] Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016[

7、J]. Clin Mol Hepatol, 2016, 22(1):7-17.[3]席浩,王保富.前入路并繞肝提拉法右半肝切除術(shù)在肝外傷的運(yùn)用[J].中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 2015,25(11):83-85.[4] Teraoku H, Arakawa Y, Yoshikawa M, et al. Complication of portal vein thrombosis after right hemihepatectomy in

8、 a patient lacking the portal vein bifurcation[J].The journal of medical investigation : JMI,2016,63(3-4):315-318. [5] Matsumoto T, Aoki T, Iso Y, et al. Successful Right Hemihepatectomy for a Patient with Right-Sided R

9、ound Ligament[J].Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract,2016,20(2):470-472. [6] Lai EC, Fan ST, Lo CM, el al. Anterior approach for difficult majior rig

10、ht hepatectomy[J]. World J Surg, 1996,20(3):314-317.[7] Machado MA, Surjan RC. Video: intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy[J]. Surgical endoscopy,2011,25(12):3930-3933.[8] Cai LX

11、, Li ZY, Fang ZP.[Application of anterior-inferior approach through retrohepatic tunnel for dissecting short hepatic veins in laparoscopic right hemihepatectomy][J]. Zhonghua yi xue za zhi,2013,93(28):2179-2182.[9] Huan

12、wei C. Pure laparoscopic right hemihepatectomy via anterior approach[J].Surgical endoscopy,2016,30(12):5621.[10 Capussotti L, Ferrero A, Russolillo N, et al. Routine anterior approach during right hepatectomy: results o

13、f a prospective randomised controlled trial[J]. J Gastrointest Surg, 2012,16(7):1324-1332.[11] Cresswell AB, Welsh FK, John TG, et al. Evaluation of intrahepatic, extra-Glissonian stapling of the right porta hepatis vs

14、. classical extrahepatic dissection during right hepatectomy[J]. HPB (Oxford),2009, 11(6):493-498.[12]王俊剛.前入路右半肝切除術(shù)與傳統(tǒng)右半肝切除術(shù)治療大肝癌的比較[J].中國(guó)普通外科雜志,2013,23 (1):18-21.[13]佟慶,晏冬,毛拉艾沙·買(mǎi)買(mǎi)提,等.前入路與傳統(tǒng)入路右半肝切除術(shù)治療肝癌療效的Meta 分析[