肝门部胆管癌根治联合血管切除重建的难点与技巧

Skills and difficulties of vascular resection and reconstruction in radical resection of hilar cholangiocarcinoma

肝门部胆管癌常常合并有肝动脉及门静脉侵犯。随着影像学和外科技术的不断发展,血管侵犯已不再是肝门部胆管癌手术禁忌。血管重建常用为对端吻合方式,胃十二指肠动脉及变异肝动脉均可作为修复材料,门静脉切除段较长时可用人工血管重建。应用门静脉栓塞及围肝门切除等技术可提高手术安全性,门脉动脉化及联合肝脏分割与门静脉支结扎的分步肝切除术(ALPPS),等术式的价值有待进一步明确。经过充分评估,实施联合血管切除重建,不仅可以明显提高肝门部胆管癌根治性切除率,还可以改善患者生存质量。

HCC is commonly associated with invasion of the hepatic artery and portal vein. With the progress of imaging and surgical technology, HCC with blood vessel invasion was no longer a contraindication. End to end anastomosis is a commom method to reconstruct blood vessel. Variants of the gastroduodenal artery and hepatic artery could be used as materials for repair. Artificial blood vessel could be used to reconstruct the portal vein. PVE and perihilar resection could be used to improve operative safety. It is necessary to further clarify the value of portal vein arterialization and ALPPS. Through preoperative assessment, combined vascular resection and reconstruction could increase the radical resection rate of HCC and improve the patient quality of life.