肝门部胆管癌手术方式的正确选择

Appropriate choice of surgical strategies in managing hilar cholangiocarcinoma

肝门部胆管癌由Klatskin在1965年首次描述，是指发生在左肝管、右肝管、左右肝管分叉部和肝总管上段的胆管黏膜上皮恶性肿瘤。其发病率近30年来有增加趋势，占胆道肿瘤的67％，多数患者预后差，术后5年的生存率〈30％，根治性R0切除是目前惟一可能获得治愈或提高长期生存率的方法。由于肝门部胆管癌解剖的复杂性以及肿瘤本身具有肝转移、淋巴结转移、周围血管侵犯及神经浸润的生物学特性，其手术治疗仍然颇为棘手。

Hilar cholangiocareinoma is a rare tumor with a poor prognosis. Due to advances in preoperative imaging and enhanced comprehension of tumor biological behavior, surgical management of hilar cholangiocarcinoma has evolved since its original description. Currently, it has been accepted that complete surgical resection provides the only possibility for cure or long-term survival, however, the surgical management of hilar cholangiocarcinoma is extremely challenging because of its anatomical location and vascular proximity. In order to achieve complete resection, several surgical approaches have been investigated and evaluated regarding major hepatic resection, lymph node dissection, vascular resection, extended resection and liver transplantation, however, there are still many disputa- tions. Furthermore, many surgical technical difficulties exist in biliary reconstruction after resection owing to anatomical problems. Focusing on the disputes and problems mentioned above, we herein review and discuss surgical strategies in managing hilar cholangiocarcinoma.