肝门部胆管癌外科治疗的现状与展望

Current Situation and Prospect of Surgical Treatment of Hilar Cholangiocarcinoma

肝门部胆管癌是一种罕见的胆道原发性肿瘤,其临床症状隐匿,早期检测方法匮乏,以至于患者总体生存率低下。手术治疗仍然是目前的主要治疗方法,包括规则性肝切除联合肝外胆管切除,淋巴结清扫,均给予患者带来长期存活和潜在治愈的可能。尤其是联合新辅助放化疗后行肝移植术,为不能切除的肿瘤患者提供了新的治疗方法。但是关于手术切除的范围、术前减黄的执行标准、动静脉的切除与重建均存在争议,亟需联合多诊疗中心开展大型临床随机对照研究以确定肝门部胆管癌手术的执行标准。

Hilar cholangiocarcinoma is a rare primary biliary tract tumor.These tumors are difficult to diagnose due to a silent clinical nature and limited early detection modalities,contributing to an overall poor survival for patients with this disease.Surgical treatment is still the main treatment,including regular liver resection combined with extrahepatic bile duct resection,lymph node dissection,offering the best chance of long-term survival and potential cure.Especially neoadjuvant chemotherapy underwent liver transplantation provides a new treatment for patients with unresectable tumors.However,the scope of surgical resection,the standards of preoperative biliary drainage and the removal and reconstruction of arteriovenous remain controversial.There is an urgent need to carry out a large-scale multi-center clinical randomized controlled study to determine the surgery standards of hilar cholangiocarcinoma.