切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 541 -545. doi: 10.3877/cma.j.issn.1674-3946.2019.06.001.

所属专题: 述评/论坛 总编推荐 文献

专家论坛

肝门部胆管癌淋巴结清扫的若干问题
王坚1,(), 何敏1   
  1. 1. 200127 上海交通大学医学院附属仁济医院胆胰外科
  • 收稿日期:2019-04-20 出版日期:2019-12-26
  • 通信作者: 王坚

Controversial issues in lymph node dissection of hilar cholangiocarcinoma

Jian Wang1,(), Min He1   

  1. 1. Department of Pancreaticobiliary surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
  • Received:2019-04-20 Published:2019-12-26
  • Corresponding author: Jian Wang
  • About author:
    Corresponding author: Wang Jian Email:
  • Supported by:
    Leading Talents funding project of Shanghai city; Shanghai three-year-plan for promoting clinical skills and clinical innovation ability of municipal hospitals——Key project for Precision diagnosis and treatment of difficult diseases(NO.16CR2002A); Training fund of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine(NO.PYII-17-007)
引用本文:

王坚, 何敏. 肝门部胆管癌淋巴结清扫的若干问题[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 541-545.

Jian Wang, Min He. Controversial issues in lymph node dissection of hilar cholangiocarcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 541-545.

肝门部胆管癌(HCCA)淋巴结清扫范围不统一,No.8、12和13组淋巴结是目前临床上比较公认的区域淋巴结清扫范围。但对于HCCA是否需行扩大淋巴结清扫、扩大淋巴结清扫的具体范围、扩大淋巴结清扫的临床意义和安全性仍存在很大争议,是HCCA治疗中的焦点和热点问题,有待通过将来开展更多的相关临床研究予以证实。

The extent of lymph node dissection in hilar cholangiocarcinoma (HCCA) remain controversial. The dissection of No.8, 12 and 13 lymph nodes are generally recognized in clinical practice. However, there are still controversial issues such as necessity, exact extent, clinical significance and safety of expanded lymph node dissection for HCCA. All of above hot issues in HCCA treatment still need to be explored by further relevant clinical studies.

图1 右肝动脉走行于肝总管前方(A:螺旋CT结果,B:术中右肝动脉肝总管位置)
图2 肝十二指肠韧带骨骼化清扫
图3 第9组淋巴结的清扫
图4 第16b1组淋巴结清扫
图5 规范的淋巴结分站清扫与病理归档
[1]
Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who underwent regional and paraaortic node dissection[J]. Ann Surg,2001,233(3): 385-392.
[2]
董家鸿,叶晟.不断提高肝门部胆管癌切除的精准化水平[J/CD].中华普外科手术学杂志:电子版,2015,9(5): 1-4.
[3]
Aoba T, Ebata T, Yokoyama Y, et al. Assessment of nodal status for perihilar cholangiocarcinoma: location, number, or ratio of involved nodes[J]. Ann Surg,2013,257(4): 718-725.
[4]
黄志强.肝门部胆管癌[J].中华消化外科杂志,2013,12(3): 166-169.
[5]
Caplan I.Drainage lymphatique intra at extra-hepatic de la vessicule biliarie[J].Bulletin Mein.Academia Medicale Belge,1982;137: 324-334.
[6]
Kurosaki I, Tsukada K, Hatakeyama K,et al.The mode of lymphatic spread in carcinoma of the bile duct[J]. Am J Surg,1996,172(3): 239-243.
[7]
Avril N, Rose CA, Schelling M,et al.Breast imaging with positron emission tomography and fluorine-18 fluonodeoxyglucose use and limitation[J].J Clin Oncol,2008,18(20): 3495-3502.
[8]
Loschner C, Nagel SN, Kausche S,et al.Hepatic arterial supply in 1297CT-angiographies[J].Rofo,2015,187(4): 276-282.
[9]
王坚.围肝门外科技术处理围肝门胆道肿瘤[J].中华外科杂志,2018,56(5): 332-336.
[10]
王坚,陈炜.围肝门外科技术在胆道外科的应用[J].中华消化外科杂志,2015,14(4): 284-287.
[11]
何敏,王昊陆,闫加艳,等.顺逆结合肝中裂劈开肝门显露法治疗Bismuth Ⅲ、Ⅳ型肝门胆管癌的安全性与疗效分析[J].中华外科杂志,2018,56(5): 360-366.
[12]
陈炜,何敏,钱黎骏,等.顺逆结合肝门显露法取出肝内胆管金属支架[J].中华消化外科杂志,2017,16(9): 973-975.
[13]
闫加艳,陈炜,王坚.顺逆结合肝门显露法治疗侵犯肝门的肝内胆管细胞癌[J].中华消化外科杂志,2017,16(4): 417-422.
[14]
DeOliveria ML, Schulick RD, Nimura Y,et al.New Staging System and a Registryfor Perihilar Cholangiocarcinoma[J].Hepatology,2011,53(4): 1363-1371.
[15]
Miyazaki M, Ohtsuka M, Miyakawa S,et al.Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3rd English edition[J].J Hepatobiliary Pancreat Sci,2015,22(3): 181-196.
[16]
中华医学会外科学分会胆道外科学组,解放军全军肝胆外科专业委员会.肝门部胆管癌诊断和治疗指南(2013版) [J].中华外科杂志,2013,51(10): 865-871.
[17]
Giuliante F, Ardito F, Guglielmi A,et al.Association of Lymph Node Status With Survival in Patients After Liver Resection for Hilar Cholangiocarcinoma in an Italian Multicenter Analysis[J].JAMA Surg,2016,151(10): 916-922.
[18]
Kambakamba P, Linecker M, Slankamenac K,et al.Lymph node dissection in resectable perihilar cholangiocarcinoma:a systematic review[J]. Am J Surg,2015,210(4): 694-701.
[19]
Hakeem AR, Marangoni G, Chapman SJ,et al.Dose the extent of lymphadenectomy,number of lymphnodes,positive lymph node ratio and neutrophil-lymphocyte ratio impact surgical outcome of perihilar cholangiocarcinoma? [J].Eur J Gastroenterol Hepatol,2014,26(9): 1047-1054.
[20]
Murakami Y, Uemura K, Sudo T,et al.Prognostic factors after surgical resection for intrahepatic,hilar,and distal cholangiocarcinoma[J].Ann Surg Oncol,2011,18(3): 651-658.
[21]
Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma[J].Ann Surg,1996,223(4): 384-394.
[22]
Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma[J]. Ann Surg,1999,230(6): 808-818.
[23]
Tsao J, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience[J].Ann Surg,2000,232(2): 166-174.
[24]
Todoroki T, Kawamoto T, Koike N, et al. Radical resection of hilar bile duct carcinoma and predictors of survival[J]. Br J Surg,2000,87(3): 306-313.
[25]
Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma: a spectrum of intrahepatic, perihilar, and distal tumors[J]. Ann Surg,1996,224(4): 463-473.
[26]
Pereira ER, Kedrin D, Seano G, et al. Lymph node metastases can invade local blood vessels, exit the node, and colonize distant organs in mice[J]. Science,2018,359(6382): 1403-1407.
[27]
Brown M, Assen FP, Leithner A, et al. Lymph node blood vessels provide exit routes for metastatic tumor cell dissemination in mice[J]. Science,2018,359(6382): 1408-1411.
[28]
Schwarz RE, Smith DD.Lymph Node Dissection Impact on Staging and Survival of Extrahepatic Cholangiocarcinomas, Based on U.S. Population Data[J]. J Gastrointest Surg,2007,11(2): 158-165.
[29]
Mao K, Liu J, Sun J,et al.Patterns and Prognostic Value of Lymph Node Dissection for Resected Perihilar Cholangiocarcinoma[J].J Gastroenterol Hepatol,2016,31(2): 417-426.
[30]
Ito K, Ito H, Allen PJ,et al.Adequate lymph node assessment for extrahepatic bile duct adenocarcinoma[J].Ann Surg,2010,251(4): 675-681.
[1] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[4] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[5] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[6] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[7] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[8] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[9] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[10] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[11] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[12] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[13] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[14] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[15] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
阅读次数
全文


摘要