Lu Z, Wang D D
Department of General Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China.
Zhonghua Wai Ke Za Zhi. 2016 Jul 1;54(7):488-91. doi: 10.3760/cma.j.issn.0529-5815.2016.07.003.
Hilar cholangiocarcinoma (HCCA) is also known as cancer at the upper part of bile duct, perihilar cholangiocarcinoma or Klatskin tumor, etc.Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma refers to tumor invading right hepatic duct (Ⅲa) or left hepatic duct (Ⅲb). While Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma refers to both left and right intrahepatic bile ducts being invaded. Under the premise of strictly grasping the indications of surgery, if preoperative management is conducted carefully, extended hepatic resection is a safe and feasible surgery to remove Bismuth-Corlette type Ⅲ and type Ⅳ hilar cholangiocarcinoma. When conducting extended hepatic resection, right hepatectomy and combined caudate lobectomy should be conducted depending on the circumstances. Routine skeletization lymph node dissection of the hepatoduodenal ligament is performed, which could be expanded into celiac trunk, para-aortic area and the rear of pancreatic head. In the premise of radical resection, invaded vessels should be removed and then reconstructed depending on circumstances.
肝门部胆管癌(HCCA)又称胆管上段癌、肝门周围胆管癌或克氏瘤等。Bismuth-CorletteⅢ型肝门部胆管癌是指肿瘤侵犯右肝管(Ⅲa)或左肝管(Ⅲb)。而Bismuth-CorletteⅣ型肝门部胆管癌是指左右肝内胆管均受侵犯。在严格掌握手术适应证的前提下,若术前仔细管理,扩大肝切除术是切除Bismuth-CorletteⅢ型和Ⅳ型肝门部胆管癌的一种安全可行的手术。进行扩大肝切除时,应视情况行右半肝切除并联合尾状叶切除。常规行肝十二指肠韧带骨骼化淋巴结清扫,可扩展至腹腔干、主动脉旁区域及胰头后方。在根治性切除的前提下,应切除受侵血管,然后视情况进行重建。