"数智化"及微创外科时代肝血管瘤规范化治疗OA

As a common benign liver tumor,the diagnostic and therapeutic paradigm for hepatic hemangioma has shifted from experience-based judgment centered primarily on tumor size to a comprehensive assessment based on symptoms,growth rate,risk of complications,diagnostic certainty,and general condition.Multidisciplinary team(MDT)collaboration has become an important prerequisite for standardized decision-making.The therapeutic goal is to ensure efficacy while maximizing preservation of normal liver parenchyma and minimizing overtreatment.Surgery remains an important treatment modality.Enucleation is preferred because it is more consistent with the anatomical characteristics of benign lesions,whereas hepatectomy is more suitable for deeply located lesions,extensive lesions,or lesions in which preservation of the surrounding liver tissue is difficult.Perioperative management focuses on the control of bleeding risk and relies on vascular inflow occlusion,liver hanging maneuver,low central venous pressure,and the application of refined surgical devices.With the continuous development of minimally invasive surgery,laparoscopic and robotic techniques have shown advantages in the management of complex lesions,including reduced surgical trauma,faster postoperative recovery,and improved procedural precision.Three-dimensional reconstruction based on computed tomography(CT)and magnetic resonance imaging(MRI),indocyanine green(ICG)fluorescence navigation,augmented reality(AR),and artificial intelligence-assisted decision-making are driving the transition from experience-based surgery to precision surgery.In the field of interventional therapy,transcatheter arterial chemoembolization(TACE)has become an important minimally invasive option,showing favorable efficacy in reducing lesion size and relieving symptoms,and it can also serve as a bridging treatment before surgery for giant hemangiomas;however,its long-term efficacy and indications still require individualized evaluation.Ablative therapy mainly includes radiofrequency ablation(RFA)and microwave ablation(MWA),both of which are minimally invasive and efficient.Among them,MWA may offer advantages in shortening procedure time,reducing the heat-sink effect,and lowering the risk of hemolysis-related complications.In the future,diagnosis and treatment are expected to advance toward the integration of digital intelligence,optimization of combined treatment strategies,promotion of standardized systems,and individualized precision intervention,thereby achieving better clinical outcomes with less trauma.