肝门部胆管癌精准外科治疗的进展

Precise surgery of hilar cholangiocarcinoma

由于特殊的解剖学位置和生物学特性，肝门部胆管癌的治疗依旧充满挑战。目前，根治性切除仍是治疗肝门部胆管癌最有效的手段。为了达到精准外科的要求，术前需对肝门部解剖结构、肿瘤的生物学特征以及肝脏功能储备情况等予以充分了解，同时对于术前预处理、肝切除技术和血管、胆管重建技术应予充分掌握。本文总结了完善的术前评估、精准的分期、积极的术前干预、精确的可切除性判断及术式选择为核心的精准外科治疗策略对肝门部胆管癌的手术治疗的影响。肝门部胆管癌的术前分型、术前处理、手术方案精细化和标准化，可进一步提高肝门部胆管癌的手术治疗效果。

Due to the special location and biological characteristics, the therapy of hilar cholangiocarcinoma is still challenging. Curative resection can offer a better chance for long-term survival than any other therapeutic modalities for hilar cholangiocarcinoma. To meet the demand of precise surgery, the knowledge of anatomy, biological characteristics and liver functional reserve is needed and the technical aspects of pre-surgieal intervention, liver resection and reconstruction of vessels are also very important. This review highlights recent improvements in hilar cholangiocareinoma management, with special attention to the new staging system for hilar cholangiocarcinoma, the perioperative management and the accurate dissection approach to achieve more adequate tumor-free resection margin. Overall, the precise surgical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholangiocarcinoma.