复杂性肝门胆管癌手术根治的新技术

Recent advances in surgical treatment of complex hilar cholangiocarcinoma

复杂性肝门胆管癌是肝脏外科面临的巨大挑战。不仅手术难度高,手术风险更大且R0切除率低。而R0切除、侵犯淋巴结及血管切除被认为是三个独立的预后因素。近年来的手术技术进步主要包括了利用现代的影像3D技术实施术中的精准切除,对适合的患者实施保留肝实质的根治性肿瘤切除、联合肝叶及血管的切除以及合理的淋巴结清扫,以期望提高BismuthⅢ、Ⅳ型的复杂性肝门胆管癌有效切除率,提升患者的生存质量,延长生存期。

Complex hilar cholangiocarcinoma is a great challenge to surgeons in hepatic surgery,not only because of its great degree of operation difficulty,but also the high surgical risk and low R0 resection rate.Noticeably,R0 resection,lymph node infringement,and vessel resection are regarded as three independent prognostic factors for complex hilar cholangiocarcinoma.In recent years,with the advancement of surgical techniques such as precise liver resection using preoperative 3D imaging,application of radical tumor resection while preserving nor-mal liver parenchyma for patients who are suitable for this surgical process,combined hepatic resection and vascular resection,and perform-ance of reasonable extent of lymph node dissection,it is hoped to increase the curative resection rate for patients with Bismuth typeⅢandⅣcomplex hilar cholangiocarcinoma,improve their quality of life,and prolong their survival time.