Ni Qihong, Wang Haolu, Liang Xiaowen, Zhang Yunhe, Chen Wei, Wang Jian
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.
J Coll Physicians Surg Pak. 2016 Jun;26(6 Suppl):S13-5.
The combination of hilar cholangiocarcinoma and anatomic variation constitutes a rare and complicated condition. Precise understanding of 3-dimensional position of tumor in the intrahepatic structure in such cases is important for operation planning and navigation. We report a case of a 61-year woman presenting with hilar cholangiocarcinoma. Anatomic variation and tumor location were well depicted on preoperative multidetector computed tomography (MDCT) combined with 3-dimensional reconstruction as the right posterior segmental duct drained to left hepatic duct. The common hepatic duct, biliary confluence, right anterior segmental duct, and right anterior branch of portal vein were involved by the tumor (Bismuth IIIa). After carefully operation planning, we successfully performed a radical parenchyma-sparing anatomical surgery of hilar cholangiocarcinoma: Liver segmentectomy (segments 5 and 8) and caudate lobectomy. MDCTcombined with 3-dimensional reconstruction is a reliable non-invasive modality for preoperative evaluation of hilar cholangiocarcinoma.
肝门部胆管癌合并解剖变异是一种罕见且复杂的情况。对于此类病例，精确了解肿瘤在肝内结构中的三维位置对于手术规划和导航至关重要。我们报告一例61岁女性肝门部胆管癌病例。术前多排螺旋计算机断层扫描（MDCT）结合三维重建清晰显示了解剖变异和肿瘤位置，因为右后段胆管汇入左肝管。肝总管、胆管汇合处、右前段胆管和门静脉右前支均被肿瘤累及（Bismuth IIIa型）。经过仔细的手术规划，我们成功实施了保留实质的肝门部胆管癌根治性解剖手术：肝段切除术（第5和8段）及尾状叶切除术。MDCT结合三维重建是术前评估肝门部胆管癌的可靠无创检查方法。
