Kremer B, Henne-Bruns D, Soehendra N, Grimm H, Pieper F
Chirurgische Universitätsklinik Hamburg.
Chirurg. 1988 Jul;59(7):472-7.
We report about the diagnostic and therapeutic approaches in 62 cases of Klatskin tumors operated during the last 5 years. In most patients the definite treatment consisted either of primary endoscopic drainage of the bile ducts or of a secondary endoscopic drainage after explorative laparotomy. Only one third of the patients could be operated in curative intention. Operative procedures included local tumor resections as well as a central bile duct resection combined with hemihepatectomy. The main problem in these operations is to avoid a biliodigestive anastomosis with tumor infiltrated bile ducts, because these patients would have been better treated endoscopically. After extended preoperative diagnostic procedures including CT-scan, ultrasound, ERCP and angiography in most cases the criteria for irresectability can be defined and unnecessary operative interventions can be avoided.
我们报告了过去5年中接受手术治疗的62例肝门部胆管癌的诊断和治疗方法。大多数患者的明确治疗包括原发性胆管内镜引流或剖腹探查术后的继发性内镜引流。只有三分之一的患者能够进行根治性手术。手术方式包括局部肿瘤切除以及中央胆管切除联合半肝切除。这些手术的主要问题是避免与肿瘤浸润胆管进行胆肠吻合，因为这些患者采用内镜治疗效果会更好。在进行包括CT扫描、超声、内镜逆行胰胆管造影（ERCP）和血管造影等广泛的术前诊断程序后，大多数情况下可以确定不可切除的标准，避免不必要的手术干预。
