Verbeek P C, van Leeuwen D J, de Wit L T, Reeders J W, Smits N J, Bosma A, Huibregtse K, van der Heyde M N
Hepatopancreaticobiliary Unit, University of Amsterdam, The Netherlands.
Surgery. 1992 Nov;112(5):866-71.
Hilar obstructions remain a challenge with regard to diagnosis and treatment.
In the period from 1984 to 1990, 82 patients underwent resective surgery under the presumptive diagnosis of hilar cholangiocarcinoma (Klatskin tumor). The diagnosis was based on the combined appearances on direct cholangiography and ultrasonography in all cases, with the use of various other imaging modalities in some cases.
The perioperative findings from an experienced surgical team were usually thought to be compatible with bile duct carcinoma. However, histologic examination of the resected specimens revealed benign fibrosing or localized sclerosing lesions in 11 patients (13.4%).
The current state of diagnostic imaging fails as yet to discriminate reliably between benign and malignant hilar lesions. Whereas the immediate therapeutic consequences may be equal (resection followed by hepaticojejunostomy), the late consequences differ in a major way because benign disease has a much better prognosis. In the presence of suspicious hilar obstruction, operable lesions should not be treated by "palliative" intubational techniques and radiation therapy without a firm diagnosis of malignancy. However, overtreatment (extended liver resection, vascular reconstruction, and liver transplantation) should be avoided as well when a benign lesion has not been ruled out.
肝门部梗阻在诊断和治疗方面仍然是一项挑战。
在1984年至1990年期间，82例患者在初步诊断为肝门部胆管癌（克氏瘤）的情况下接受了根治性手术。所有病例的诊断均基于直接胆管造影和超声检查的综合表现，部分病例还使用了其他各种成像方式。
经验丰富的手术团队的围手术期检查结果通常被认为与胆管癌相符。然而，对切除标本的组织学检查显示，11例患者（13.4%）存在良性纤维化或局限性硬化性病变。
目前的诊断成像技术尚无法可靠地区分肝门部良性和恶性病变。虽然直接的治疗结果可能相同（切除后行肝空肠吻合术），但由于良性疾病的预后要好得多，晚期结果存在很大差异。在存在可疑的肝门部梗阻时，在未明确诊断为恶性肿瘤的情况下，不应通过“姑息性”插管技术和放射治疗来处理可手术切除的病变。然而，在未排除良性病变的情况下，也应避免过度治疗（扩大肝切除、血管重建和肝移植）。
