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) : 546 -549. doi: 10.3877/cma.j.issn.1674-3946.2019.06.002.

所属专题: 述评/论坛 总编推荐 文献

专家论坛

肝门部胆管癌根治术式选择与意义
李相成1,(), 江王杰1, 焦臣宇1   
  1. 1. 210029 南京,南京医科大学第一附属医院,江苏省人民医院肝胆中心
  • 收稿日期:2019-08-08 出版日期:2019-12-26
  • 通信作者: 李相成

Options and significance of radical resection for hilar cholangiocarcinoma

Xiangcheng Li1,(), Wangjie Jiang1, Chenyu Jiao1   

  1. 1. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University; Hepatobiliary center of Jiangsu People’s Hospital, Jiangsu 210029, China
  • Received:2019-08-08 Published:2019-12-26
  • Corresponding author: Xiangcheng Li
  • About author:
    Corresponding author: Li Xiangcheng, Email:
  • Supported by:
    National Natural Science Foundation of China(NO.81670570)
引用本文:

李相成, 江王杰, 焦臣宇. 肝门部胆管癌根治术式选择与意义[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 546-549.

Xiangcheng Li, Wangjie Jiang, Chenyu Jiao. Options and significance of radical resection for hilar cholangiocarcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 546-549.

组织学切缘阴性的根治性切除可以延长肝门部胆管癌患者术后长期生存率。精准的肝区段切除、合适的淋巴结清扫范围及成熟的血管重建技术是提高根治性切除的关键。本文将介绍肝门部胆管癌根治术式选择及提高根治性切除率的措施。

The long-term survival rate of patients with hilar cholangiocarcinoma could be improved by radical resection with negative histological margin. The key points to improve the radical resection is precise segmental resection of the liver, appropriate scope of lymphadenectomy and experienced vascular reconstruction skill. This article will introduce the options of radical operation and the measures to improve the radical resection rate of hilar cholangiocarcinoma.

图1 根据肝门部胆管癌患者肿瘤实际累及程度及解剖变异设计个体化精准手术方案
[1]
Rizvi S, Khan SA, Hallemeier CL,et al.Cholangiocarcinoma evolving concepts and therapeutic strategies[J]. Nat Rev Clin Oncol, 2018, 15(2): 95-111.
[2]
Razumilava N, Gores GJ.Cholangiocarcinoma[J]. Lancet, 2014, 383(9935): 2168-2179.
[3]
Hartog H, Ijzermans JN, Van Gulik TM,et al. Resection of Perihilar Cholangiocarcinoma[J]. Surg Clin North Am,2016, 96(2): 247-267.
[4]
Nagino M.Perihilar cholangiocarcinoma: a surgeon′s viewpoint on current topics[J]. J Gastroenterol, 2012, 47(11): 1165-1176.
[5]
Klempnauer J, Ridder GJ, Werner M, et al. What constitutes long term survival after surgery for hilar cholangiocarcinoma? [J]. Cancer,1997,79(1): 26-34.
[6]
Miyazaki M, Kimura F, Shimizu H, et al. Extensive hilar bile duct resection using a transhepatic approach for patients with hepatic hilar bile duct diseases[J]. Am J Surg,2008,196(1): 125-129.
[7]
Sano T, Shimada K, Sakamoto Y, et al. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality[J]. Ann Surg,2006,244 (2): 240-247.
[8]
Lim JH, Choi GH, Choi SH,et al.Liver Resection for Bismuth Type I and Type Ⅱ Hilar Cholangiocarcinoma[J]. World J Surg, 2013, 37(4): 829-837.
[9]
Xiong J, Nunes QM, Huang W,et al. Major hepatectomy in Bismuth types I and Ⅱ hilar cholangiocarcinoma[J]. J Surg Res,2015, 194(1): 194-201.
[10]
Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer - Application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization[J]. Ann Surg,2003,238(1): 84-92.
[11]
Ikeyama T, Nagino M, Oda K,et al.Surgical approach to bismuth type I and Ⅱ hilar cholangiocarcinomas : audit of 54 consecutive cases[J].Ann Surg,2007,246(6): 1052-1057.
[12]
Chen XP, Lau WY, Huang ZY, et al. Extent of liver resection for hilar cholangiocarcinoma[J]. Br J Surg,2009,96(10): 1167-1175.
[13]
Miyazaki M, Ito H, Nakagawa K, et al. Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? [J]. Surgery,1998,123(2): 131-136.
[14]
Matsumoto N, Ebata T, Yokoyama Y, et al. Role of anatomical right hepatic trisectionectomy for perihilar cholangiocarcinoma[J]. Br J Surg,2014,101(3): 261-268.
[15]
Hosokawa I, Shimizu H, Yoshidome H, et al. Surgical strategy for hilar cholangiocarcinoma of the left-side predominance: current role of left trisectionectomy[J]. Ann Surg,2014,259(6): 1178-1185.
[16]
Conci S, Ruzzenente A, Sandri M, et al. What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes[J]. Eur J Surg Oncol, 2017, 43(4): 743-750.
[17]
Hartog H, Ijzermans JN, van Gulik TM, et al. Resection of perihilar cholangiocarcinoma[J]. Surg Clin North Am,2016,96(2): 247-267.
[18]
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.
[19]
Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the "new era" :the Nagoya University experience[J]. J Hepatobiliary Pancreat Sci,2010,17(4): 449-454.
[20]
Bagante F, Tran T, Spolverato G, et al. Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme[J]. J Am Coll Surg,2016,222(5): 750-759.
[21]
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.
[22]
Rocha FG, Matsuo K, Blumgart LH, et al. Hilar cholangiocarcinoma: the Memorial Sloan-Kettering Cancer Center experience[J]. J Hepatobiliary Pancreat Sci,2010,17(4): 490-496.
[23]
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.
[24]
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.
[25]
Amin MB, Edge S, Greene F, et al. American Joint Committee on Cancer (AJCC) Cancer Staging Manual. 8th ed[J]. New York: Springer, 2017.
[26]
Matsuyama R, Mori R, Ota Y,et al. Significance of Vascular Resection and Reconstruction in Surgery for Hilar Cholangiocarcinoma: With Special Reference to Hepatic Arterial Resection and Reconstruction[J]. Ann Surg Oncol, 2016, 23(Suppl 4): 475-484.
[27]
de Jong MC, Marques H, Clary BM, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases[J].Cancer,2012,118(19): 4737-4747.
[28]
Matsuyama R, Mori R, Ota Y,et al.Significance of Vascular Resection and Reconstruction in Surgery for Hilar Cholangiocarcinoma: With Special Reference to Hepatic Arterial Resection and Reconstruction[J]. Ann Surg Oncol,2016,23(Suppl 4): 475-484.
[29]
Neuhaus P, Thelen A, Jonas S,et al. Oncological superiority of hilar en bloc resection for the treatment of hilar cholangiocarcinoma[J]. Ann Surg Oncol,2012,19(5): 1602-1608.
[30]
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.
[1] 钟锴, 蒋铁民, 张瑞青, 吐尔干艾力·阿吉, 邵英梅, 郭强. 加速康复外科在肝囊型棘球蚴病肝切除术中的应用分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 425-429.
[2] 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.
[3] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[4] 赖全友, 高远, 汪建林, 屈士斌, 魏丹, 彭伟. 三维重建技术结合腹腔镜精准肝切除术对肝癌患者术后CD4+、CD8+及免疫球蛋白水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 651-654.
[5] 唐梅, 周丽, 牛岑月, 周小童, 王倩. ICG荧光导航的腹腔镜肝切除术临床意义[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 655-658.
[6] 胡森焱, 徐冬, 方健, 谢冬冬, 王财庆. ICG荧光显影Laennec膜入路腹腔镜解剖性肝切除的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 513-516.
[7] 林巧, 周丽. RFA联合LAH术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 521-524.
[8] 曾繁利, 齐秩凯, 杨贺庆. 两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌的肿瘤学疗效及风险比对[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 525-527.
[9] 张金华, 赵锁. 早期ICC腹腔镜肝切除术不同淋巴结清扫范围的近远期效果对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 578-581.
[10] 施一辉, 张平新, 朱勇, 杨德林. 机器人辅助前列腺根治术后切缘阳性的研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 633-637.
[11] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[12] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[13] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[14] 吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[15] 吴雪云, 胡小军, 范应方. 肝切除术中剩余肝再生能力的评估与预测[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 894-897.
阅读次数
全文


摘要