Hirano Satoshi, Kondo Satoshi, Tanaka Eiichi, Shichinohe Toshiaki, Tsuchikawa Takahiro, Kato Kentaro
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(4):502-7. doi: 10.1007/s00534-009-0093-7. Epub 2009 Apr 10.
BACKGROUND/PURPOSE: Locoregional recurrence following resection of hilar biliary cancers could be caused by the microscopic dissemination of cancer cells during dissection of the portal vein from the involved bile duct at the hilar region. This retrospective study assessed the feasibility and safety of a new procedure consisting of right-sided hepatectomy, caudate lobectomy, and bile duct resection combined with routine resection of the portal bifurcation to enable no-touch resection of hilar malignancies.
Of 64 patients who underwent right-sided hepatectomy for hilar biliary cancer, the portal bifurcation was routinely resected by the above new procedure in 25 patients, based on preoperative imaging diagnoses. Perioperative outcomes were compared with those in patients who underwent conventional portal reconstruction (n = 18) and with those in patients who had preservation of the portal bifurcation (n = 21).
Perioperative data from patients with routine portal reconstruction were similar to those in the patients with conventional portal reconstruction and the patients without portal reconstruction. There were no postoperative complications directly related to portal reconstruction.
No-touch resection of hilar malignancies with right hepatectomy and the routine use of portal reconstruction was feasible and safe. The oncologic impact of this technique merits further evaluation.
背景/目的：肝门部胆管癌切除术后的局部区域复发可能是由于在肝门区域从受累胆管分离门静脉时癌细胞的微小播散所致。本回顾性研究评估了一种新手术的可行性和安全性，该手术包括右半肝切除、尾状叶切除、胆管切除以及常规门静脉分叉切除，以实现肝门部恶性肿瘤的非接触性切除。
在64例行肝门部胆管癌右半肝切除的患者中，根据术前影像学诊断，25例患者采用上述新手术常规切除门静脉分叉。将围手术期结果与行传统门静脉重建的患者（n = 18）以及保留门静脉分叉的患者（n = 21）进行比较。
常规门静脉重建患者的围手术期数据与传统门静脉重建患者和未进行门静脉重建患者的数据相似。没有与门静脉重建直接相关的术后并发症。
采用右半肝切除和常规门静脉重建进行肝门部恶性肿瘤的非接触性切除是可行且安全的。该技术的肿瘤学影响值得进一步评估。
