Emilio Ramos, Department of General Surgery, Hospital Universitario de Bellvitge, Universidad de Barcelona, 08907 Barcelona, Spain.
World J Gastrointest Oncol. 2013 Jul 15;5(7):139-46. doi: 10.4251/wjgo.v5.i7.139.
The aim of this article is to describe the surgical techniques for the treatment of hilar cholangiocarcinoma (HC). Resection with microscopically negative margin (R0) is the only way to cure patients with HC. Today, resection of the caudate lobe and part of segment IV, combined with a right or left hepatectomy, bile duct resection, lymphadenectomy of the hepatic hilum and sometimes vascular resection, is the standard surgical procedure for HC. Intraoperative frozen-section examination of proximal and distal biliary margins is necessary to confirm the suitability of resection. Although lymphadenectomy probably has little direct effect on survival, inaccurate staging information may influence post resection treatment recommendations. Aggressive venous and arterial resections should be undertaken in selected cases to achieve a R0 resection. The concept of "no-touch proposed" in 1999 by Neuhaus et al combine an extended right hepatectomy with systematic portal vein resection and caudate lobectomy avoiding hilar dissection and possible intraoperative microscopic dissemination of cancer cells. More recently minor liver resections have been proposed for treatment of HC. As the hilar bifurcation of the bile ducts is near to liver segments IV, V and I, adequate liver resection of these segments together with the bile ducts can result in cure.
本文旨在描述肝门部胆管癌（HC）的手术治疗技术。肝门部胆管癌唯一的治愈方法是行根治性切除（R0），即无肉眼肿瘤残留的边界。目前，尾叶和 IV 段联合右半肝或左半肝切除、胆管切除、肝门淋巴结清扫术，有时还包括血管切除，已成为 HC 的标准手术方式。为了确认切除的适宜性，术中需要对近端和远端胆管边缘进行冰冻切片检查。虽然淋巴结清扫术对生存可能没有直接影响，但不准确的分期信息可能会影响术后治疗建议。在某些情况下，应积极进行静脉和动脉切除，以实现 R0 切除。1999 年，Neuhaus 等人提出了“无触摸”的概念，即将广泛的右半肝切除术与系统门静脉切除术和尾叶切除术相结合，避免肝门部解剖和可能的术中肿瘤细胞的显微镜下播散。最近，有人提出对肝门部胆管癌进行小范围肝切除术。由于肝内胆管的分叉靠近 IV、V 和 I 段，因此这些段的充分肝切除加上胆管切除可以达到治愈的效果。
