Seehofer D, Kamphues C, Neuhaus P
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Chirurg. 2012 Mar;83(3):221-8. doi: 10.1007/s00104-011-2177-6.
Curative treatment of Klatskin tumors by radical surgical procedures with surgical preparation distant to the tumor region results in 5-year survival rates of 30-50%. This requires mandatory en bloc liver resection and resection of the extrahepatic bile duct often together with vascular resection. Nevertheless, the ideal safety margin of 0.5-1 cm remote from the macroscopic tumor extensions cannot be achieved in all cases. Based on hilar anatomy the probability of an adequate safety margin is higher using extended right hemihepatectomy together with portal vein resection compared to left hemihepatectomy. However, due to severe atrophy of the left liver lobe solely left-sided hepatectomy is feasible in some patients. In cases of eligibility for both procedures right hemihepatectomy is preferentially used due to the higher oncological radicality if sufficient liver function is present. Postoperative hepatic insufficiency and bile leakage after demanding biliary reconstruction, often with several small orifices, contribute to the postoperative complication rate of this complex surgical disease pattern.
通过远离肿瘤区域进行手术准备的根治性手术对肝门部肿瘤进行根治性治疗，5年生存率为30%-50%。这需要进行整块肝切除，肝外胆管切除通常还需联合血管切除。然而，并非所有病例都能实现距肉眼可见肿瘤边缘0.5-1厘米的理想安全切缘。基于肝门部解剖结构，与左半肝切除相比，扩大右半肝切除联合门静脉切除获得足够安全切缘的概率更高。然而，由于左肝叶严重萎缩，部分患者仅行左侧肝切除也是可行的。在两种手术方式均适用的情况下，如果肝功能足够，优先选择右半肝切除，因为其肿瘤根治性更高。在进行复杂的胆道重建（通常有多个小孔）后，术后肝衰竭和胆漏会导致这种复杂手术疾病模式的术后并发症发生率升高。
