肝门部胆管癌外科治疗的问题与对策

Problems and countermeasures in surgical therapy of hilar cholangiocarcinoma

手术切除是目前肝门部胆管癌获得治愈和患者长期生存的惟一希望。肝叶切除、肝外胆管切除、区域性淋巴结清扫以及胆道重建是目前肝门部胆管癌的主要手术方式。由于肿瘤本身具有侵袭性以及缺乏有效的术后辅助治疗方法，即使是在精准外科治疗时代，肝胆外科医师依然面临挑战。在术前可切除性评估和分期、术前胆道引流和门静脉栓塞、肝切除的范围、联合门静脉切除重建、联合肝动脉切除以及淋巴结清扫范围等方面存有诸多争议。本文聚焦肝门部胆管癌外科治疗的相关问题并提出对策。

Surgical resection offers hilar cholangiocar- cinoma patients the only chance for cure and long-term survival. Hepatectomy, extrahepatic bile duct resection, regional lymph- adenectomy and hepatojejunostomy are the current treatment of choice for most patients with hilar cholangiocarcinoma. Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy, surgical therapy still remains a challenge to hepatopancreatobiliary surgeons even in the precise surgery era. Controversies exist over preoperative assessment and staging, the use of preoperative biliary drainage, preoperative portal vein embolization, the range of hepatic resec- tion, portal vein resection and construction, hepatic arteriectomy and the range of lymphadenectomy. This article reviews the surgical management of hilar cholangiocarcinoma with a focus on these controversies.