联合血管切除与重建在肝门部胆管癌外科治疗中的应用

Clinical application of combined vascular resection and reconstruction in surgical treatment of hilar cholangiocarcinoma

肝门部胆管癌的外科治疗是肝胆外科领域中最具挑战性的常规手术之一。而血管侵犯是导致肝门部胆管癌根治性切除率低的重要原因。目前,学者们普遍公认受侵犯的门静脉切除重建是提高肝门部胆管癌R0切除率以及远期生存率的关键因素。然而,对于肝动脉受侵犯以后是否行切除重建目前仍存争议。结合既往文献和本中心临床治疗实践,阐述了联合血管切除与重建在肝门部胆管癌外科治疗中的应用及前景。指出随着计算机辅助外科技术的进步,以及更多病例资料的总结,联合血管切除重建在肝门部胆管癌中的适应证及远期疗效等问题仍需要进一步探索和研究。

The surgical treatment of hilar cholangiocarcinoma is one of the most challenging routine surgeries in the field of hepatobiliary surgery,and vascular invasion is an important reason for the low rate of radical resection in hilar cholangiocarcinoma. Currently,it is universally acknowledged that resection and reconstruction of the portal vein invaded is a key factor in improving R0 resection rate and long- term survival rate in patients with hilar cholangiocarcinoma. However,whether to perform resection and reconstruction after invasion of hepatic artery is still controversial. With reference to published literature and clinical practice in our center,this article introduces the application and prospects of combined vascular resection and reconstruction in the surgical treatment of hilar cholangiocarcinoma and points out that with the development of computer- assisted surgery and summarization of more and more case data,indications and long- term efficacy of combined vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma await further investigation and research.