肝门部胆管癌外科诊疗中存在争议的若干问题

Controversial issues in surgical management of hilar cholangiocarcinoma

认为肝门部胆管癌应与该区域其他良恶性疾病相鉴别，其分型问题仍需深入研究。肝门部胆管癌应开展多学科综合治疗，积极实施根治性切除术应为首选，对条件合适的首次仅行手术引流和初次手术已行病灶切除、但目前存在肿瘤局部复发的肝门部胆管癌，应积极争取再次手术实施根治性切除，有望获得长期存活。肝门部胆管癌行半肝切除、受累血管切除、实施再次手术切除等有望提高根治性切除率，但同时亦明显增加了出现严重手l术并发症的风险，需根据实际病情审慎决定。

Hilar cholangiocarcinoma should be identi- fied from other malignant tumors and/or benign disease involving the hilum which may present similar image features. Clinal stage need to be further studied. Radical resection should be recommended in multidisciplinary treatment of hi- lar cholangiocarcinoma. The patients who were received initial surgical drainage and/or local recurrence after initial sur- gical resection of hilar cholangiocarcinoma, should actively be given the opportunity of radical reoperation, with poten- tial long-term survival. Extended surgical resection resulted in increased rate of R0 resections and significantly improved survival. However, it also significantly increased the risk of serious postoperative complications, which must be balanced between survival advantage and surgical risk.