摘要
肝门部胆管癌是常见胆道恶性肿瘤,其外科治疗的核心是达到R0切除,包括切除病变胆管、受肿瘤浸润肝组织及区域淋巴结。在精准外科及多学科治疗时代,肝门部胆管癌的手术治疗应遵循可视化、可量化、可控化和多学科治疗原则。基于精准肝门部胆管癌董氏分型,包括Ⅰ+Ⅳ+Ⅴ+Ⅷ段、Ⅰ+Ⅴ+Ⅷ段及Ⅰ+Ⅳ段的中肝叶联合尾状叶切除术,在获得R0切除的同时可最大限度保留更多肝实质,使部分病人避免术前进行减轻黄疸治疗和分期手术。然而,在获得良好围术期效果的同时,还需随访评价病人的长期生存情况。笔者结合团队开展中肝叶联合尾状叶切除术的临床经验,探讨其在肝门部胆管癌中的应用。
Hilar cholangiocarcinoma(HCCa)is the most common malignant tumor of the biliary tract.The key to the surgical treatment of HCCa is R0 resection which requires not only the removal of the affected bile duct but also the associated regional lymph nodes and liver tissue.Due to the rapidly development of precision surgery and multidisciplinary therapy in recent years,visible,quantifiable,controllable operation and comprehensive therapy have become the new principles that should be followed in HCCa treatment.According to the Dong's hilar cholangiocarcinoma classification,it is possible to obtain R0 resection and preserve liver parenchyma maximally at the same time when performing mesohepatectomy combined with caudate lobectomy,including S1+S4+S5+S8,S1+S5+S8 or S1+S4 segmental hepatectomy.Meanwhile,it helps to reduce postoperative complications and can prevent biliary drainage or staging surgery in some patients.However,long-term follow-up is still needed for the survival analysis in addition to the satisfied perioperative outcomes.Based on their clinical experiences,the authors discuss the application of meso-hepatectomy with caudate lobectomy in hilar cholangiocarcinoma.
作者
陈亚进
周睿
Chen Yajin;Zhou Rui(Department of Hepatobiliary Surgery,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2021年第1期52-58,共7页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81972263)。
关键词
胆道肿瘤
肝门部
中肝叶切除
R0切除
肝实质保留
Biliary tract neoplasms
Hilar
Mesohepatectomy
R0 resection
Preser-vation of liver parenchyma
