Lidsky Michael E, Jarnagin William R
Department of Surgery Memorial Sloan Kettering Cancer Center New York NY USA.
Ann Gastroenterol Surg. 2018 Jun 29;2(4):304-312. doi: 10.1002/ags3.12181. eCollection 2018 Jul.
Hilar cholangiocarcinoma, which represents approximately 60% of biliary tract malignancies, is increasing in incidence and presents an ongoing challenge for patients and hepatobiliary surgeons. Although the majority of patients present with advanced disease, the remaining minority of patients are best treated with surgical resection or transplant. Transplant is typically reserved for locally unresectable tumors often in the setting of underlying hepatic dysfunction and will not be discussed herein. This review, therefore, focuses on oncological resection and the strategies implemented for the treatment of hilar cholangiocarcinoma at a quaternary referral center, including preoperative considerations such as patient selection and optimization of the future liver remnant, nuances to the operative approach for these tumors such as resection under low central venous pressure and management of the bile duct, as well as postoperative management.
肝门部胆管癌约占胆道恶性肿瘤的60%，其发病率正在上升，给患者和肝胆外科医生带来了持续的挑战。尽管大多数患者就诊时已处于疾病晚期，但其余少数患者最好接受手术切除或移植治疗。移植通常用于局部不可切除的肿瘤，且常伴有潜在的肝功能障碍，本文对此不作讨论。因此，本综述重点关注四级转诊中心对肝门部胆管癌进行肿瘤切除及治疗所实施的策略，包括术前考虑因素，如患者选择和未来肝残余体积的优化，此类肿瘤手术方法的细微差别，如低中心静脉压下的切除和胆管处理，以及术后管理。
