基于MIOT.CC 2024的微创入路肝移植:证据、挑战与中国路径

Minimally invasive approach liver transplantation based on MIOT.CC 2024: evidence, challenges and China’s development path

  • 摘要: 过去二十余年,腹腔镜与机器人技术不断推动肝胆外科向微创方向发展,微创入路肝移植也逐渐成为新的探索方向。但肝移植不同于常规肝切除,除病肝切除外,还包括移植物植入以及血管、胆道重建;同时,供者端和受者端在手术目标、风险结构和伦理要求上差异明显,不能简单照搬普通肝脏微创外科经验。现有证据表明,供者端微创肝切取起步较早,围手术期安全性和恢复获益已有较明确依据;而受者端,特别是全腹腔镜或机器人移植物植入,目前仍主要来自高手术量中心的小样本经验,长期结局和跨中心可复制性仍需进一步验证。本文以2024年微创入路器官移植共识(MIOT.CC)为切入点,综述微创入路肝移植在供者端和受者端的研究进展、现实问题及国内实践,以期为我国微创入路肝移植提供参考。

     

    Abstract: Over the past two decades, laparoscopic and robotic techniques have continuously advanced hepatobiliary surgery toward minimally invasive practice, rendering minimally invasive approach liver transplantation an emerging research frontier. Distinct from routine hepatectomy, liver transplantation involves not only diseased liver resection but also graft implantation as well as vascular and biliary reconstruction. Furthermore, donor and recipient sides differ substantially in surgical objectives, risk profiles and ethical criteria, precluding direct extrapolation of experience from conventional minimally invasive liver surgery. Available clinical evidence has confirmed solid perioperative safety and recovery benefits for minimally invasive living donor hepatectomy, which was developed at an earlier stage. In contrast, recipient-side procedures, especially totally laparoscopic or robotic graft implantation, are currently supported predominantly by small-cohort data from high-volume transplant centers, with long-term outcomes and cross-center reproducibility remaining to be verified. Based on the 2024 Consensus on Minimally Invasive Organ Transplantation (MIOT.CC), this article reviews research advances, practical obstacles and domestic clinical practices of minimally invasive liver transplantation from both donor and recipient perspectives, to inform the development of minimally invasive liver transplantation in China.

     

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