肝门部胆管癌根治性切除手术技巧

Surgical techniques in the radical resection of hilar cholangiocarcinoma

肝门部胆管癌是具有挑战性的疑难病症，其根治性切除一直是外科医生不断追求的目标之一。围手术期治疗策略的优化，影像学技术的提高，特别是手术器械的改进为肝门部胆管癌治疗的发展起到了重要的推动作用。肝门部胆管癌手术策略的制定以及规范化操作是获得满意远期疗效的基础。多个中心的研究结果表明，

Hilar cholangiocarcinoma remains a formidable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocareinoma resection, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopancreatoduodenectomy and liver transplantation for hilar cholangiocarcinoma treatment. In the current hepatic procedures, promising survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholangiocarcinoma.