提高肝门部胆管癌疗效的思考

Thoughts on improving the efficacy of hilar cholangiocarcinoma

近20年来，外科医生一直试图通过根治性手术来提高肝门部胆管癌的疗效。虽然国内外的手术切除率由10．0％左右上升至54．3％～83．3％，根治性切除率提高到了30．0％～50．0％，但5年生存率只有10．0％～45．0％，中位生存时间仅12～24个月，总体疗效仍不令人满意。黄志强院士提出肝门部胆管癌的常规手术切除进入了瓶颈，应寻求治疗观念上的突破，才能取得更好的疗效。

Hilar cholangiocarcinoma still has a poor prognosis and a relatively low 5-year survival rate despite improvemenl of the resection rate and curative resection rate. Optimal surgical strategies should be chosen according to the balance between operation safety and curative resection. Extended resection and dissection of lymph nodes do not always ensure successful treatment. Preoperative evaluation of liver function should be carefully carried out. For patients with severe jaundice or those who undergo extensive hepatic resection, preoperative biliary drainage, portal vein embolization and a precise hepatectomy technique should be carried out to improve the safety of the operation. Assessment of resectability should be carried out to avoid unnecessary laparotomy, and endoscopic drainage is preferable in dealing with unresectable tumors. The aim of palliative treatment is to relieve biliary obstruction, prolong life and improve the quality of life. Biological characteristics of hilar cholangiocarcinoma need to be taken into account and muhimodality therapy is required to improve treatment. The survival rate of patients with hilar cholangiocarcinoma may be improved by comprehensive treatment. Populations with high risks should be monitored and screened to find patients at early stages of the disease.