局部进展期肝门部胆管癌的外科治疗策略  

Surgical approach for locally advanced hilar cholangiocarcinoma

作　　者：李相成 王子奕 Li Xiangcheng;Wang Ziyi(Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院肝胆中心,210029

出　　处：《中华消化外科杂志》2021年第8期858-863,共6页Chinese Journal of Digestive Surgery

基　　金：江苏省重点病种规范化诊疗研究(BE2016789)。

摘　　要：肝门部胆管癌恶性程度较高,确诊时多为局部进展期。外科手术切除仍是唯一的根治性疗法,如何安全、有效地开展根治性切除已成为肝脏外科医师关注重点。对于局部进展期肝门部胆管癌,积极的外科治疗策略可增加肿瘤的根治性切除率。联合全尾状叶切除的半肝或肝三叶切除术为肝门部胆管癌根治术的标准手术方式,可选择性地开展血管切除重建及淋巴结清扫术。笔者认为:细致的术前评估和管理,如术前胆道引流和门静脉栓塞等措施,可有效预防术后并发症,为施行手术提供安全保证。局部进展期肝门部胆管癌的治疗仍然需要多学科团队的密切合作,积极的手术与辅助治疗相结合可进一步提高肿瘤的切除率和病人生存率。Hilar cholangiocarcinoma is a highly intractable malignancy,and most patients with this disease were diagnosed as a locally advanced stage at their initial presentation.Surgical resection remains as the only curative treatment for hilar cholangiocarcinoma.Hepatic surgeons focus on how to perform radical resection safely and effectively.For locally advanced hilar cholangio-carcinoma,aggressive surgical approach substantially increases the resectability of tumors which were initially regarded as unresectable.Hemihepatectomy or trisectionectomy combined with caudate lobectomy is the standard operation for radical resection of hilar cholangiocarcinoma,vascular resection and lymphadenectomy can be performed selectively.The safety and success of surgical approach is guaranteed by meticulous preoperative management such as preoperative biliary drainage and portal vein embolization,which prevent fatal postoperative complications.Multidisciplinary approach is required for the treatment of hilar cholangiocarcinoma.The combina-tion of aggressive surgical approach and adjuvant therapy remain a promising approach for further improving the resectability of tumors and the survival of patients.

关 键 词：胆管肿瘤 肝门部 局部进展期 术前胆道引流 门静脉栓塞 肝三叶切除术 门静脉切除重建 

分 类 号：R735.8[医药卫生—肿瘤]