肝门部胆管癌根治术关键技术标准及评价

Key technical criteria and evaluation for radical resection of hilar cholangiocarcinoma

肿瘤根治性切除是肝门部胆管癌最为有效的治疗方式,也是肝胆外科最具挑战性的技术领域。合理有效的术前准备方案以及规范的手术方案,是实现高质量肝门部胆管癌根治性切除的必要条件。肝门部胆管癌外科治疗涉及多个核心环节,包括肿瘤可切除性和肝储备功能评估、术前准备、手术操作及术后并发症处理等。有效的术前准备包括无创性影像学检查、胆道引流、肝体积测量、选择性门静脉栓塞术等,目的是减少高胆红素血症的影响、改善肝功能、确保大范围肝切除安全性。围肝门解剖、肝切除范围、门静脉切除重建、肝动脉切除重建、区域淋巴结清扫范围等是肿瘤根治性切除关键技术,目的是实现所有切缘阴性,彻底清除肿瘤及其侵袭的组织。肝门部胆管癌外科治疗仍存在诸多争议点,如术前胆道引流途径及周期、肝切除范围、肝动脉重建的必要性、淋巴结清扫数目等,仍有待进行更多临床研究以形成共识。

Radical resection is the most effective treatment for hilar cholangiocarcinoma,and it is also the most challengintgechnica1l fieldin hepatobiliarysurgery.Reasonable and effective preoperative preparation plan and standard operation plan are the necessary conditions to achieve highquality radical resection of hilar cholangiocarcinoma.Surgical treatment of hilar cholangiocarcinoma involves multiple core aspects,including assessment of tumor resectability and liver reserve function,preoperative preparation,surgical procedure,sa,nd postoperative complication management.Effective preoperative preparation includes non-invasive imaging examinations,biliary drainage,liver volume measurement,and selective portal vein embolization,aimed at reducing the impact of hyperbilirubinemia,improving liver function,and ensuring safery in major liver resection.Key technical aspects of radical tumor resection involve peri-hilar anatomy understanding,extent of liver resection,portal vein resection and reconstruction,hepatic artery resection and reconstruction,and regional lymph node dissection,aiming to achieve negative margins,thoroughly removing the tumor,and invasive tissues.Surgical treatment of hilar cholangiocarcinoma still faces various controversies,such as the approach and timing of preoperative biliary drainage,extent of liver resection,necessity of hepatic artery reconstruction,and the number of lymph node dissections,requiring further clinical research for consensus formation.