Wang J
Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Zhonghua Wai Ke Za Zhi. 2018 May 1;56(5):332-337. doi: 10.3760/cma.j.issn.0529-5815.2018.05.003.
Perihilar biliary tract tumours include hilar cholangiocarcinoma, gallbladder cancer invading the hepatic hilum and intrahepatic cholangiocarcioma invading the hepatic hilum.The tumours have the special characteristics such as strong invasion capability, the anatomic variant, the pathophysiological complexity, the biological behavior diversity and the difficulty of preoperative evaluation which result in low R0 resection rate, more postoperative complications, more mortality and poor prognosis.The perihilar surgical techniques system aims to set a reasonable and individual operation procedure on the principle of precision surgery by taking the key technique of hilar dissection and exposing, evaluting the hilar anatomy by the means of three-dimensional digital medical image evaluation system, evaluting the relationship between the tumour and hepatic artery and portal vein under the condition of hepatic hilum complete exposure by combining anterograde and retrograde route from intra and extra-hepatic direction to hepatic hilum.The perihilar surgical techniques system is applied to improve the accuracy of resectable evaluation, the R0 radical resection rate, the safety of operation and the accuracy of cholangiojejunostomy through the accurate preoperative evaluation, the detailed operation plan, the accurate intraoperative reassessment, the perfect operative procedure and the excellent postoperative management, eventually for the purpose of reducing the postoperative complications rate and perioperative mortality and improving the prognosis of perihilar biliary tract tumours.
肝门部胆道肿瘤包括肝门部胆管癌、侵犯肝门的胆囊癌和侵犯肝门的肝内胆管癌。这些肿瘤具有侵袭能力强、解剖变异、病理生理复杂、生物学行为多样以及术前评估困难等特点，导致R0切除率低、术后并发症多、死亡率高且预后差。肝门部手术技术体系旨在以精准外科为原则，通过采用肝门部解剖与显露的关键技术，借助三维数字医学影像评估系统评估肝门部解剖结构，在肝门部完全显露的情况下，从肝内外方向联合顺行和逆行路径至肝门部，评估肿瘤与肝动脉和门静脉的关系，从而制定合理且个体化的手术方案。肝门部手术技术体系通过准确的术前评估、详细的手术规划、精确的术中再评估、完善的手术操作流程以及出色的术后管理，应用于提高可切除性评估的准确性、R0根治性切除率、手术安全性以及胆肠吻合的准确性，最终目的是降低术后并发症发生率和围手术期死亡率，改善肝门部胆道肿瘤的预后。
