Ruiz E, Celis J, Sullón J
Rev Gastroenterol Peru. 1995 May-Aug;15(2):167-75.
Usually primary cancer originating in the hepatic duct confluence (Klatskin Tumor) is regarded as unresectable at diagnosis and therefore percutaneously or endoscopically placed stents have been advocated. Unfortunately with these palliative modalities the median survival is only 3-6 months. However with aggressive surgical resection of the tumor 17% of five year survival have been obtained. The present paper summarizes our experience from three patients with Klatskin tumor which underwent surgery. The Klatskin tumors were Type II (one case), Type IIIa (one case) and Type IIIb (one case). The patient with tumor Type II had wide tumor excision and extrahepatic bile duct resection at the liver hilum. The patients with tumor Type III had extrahepatic bile duct resection at the liver hilum with left and right hepatectomy respectively. Reconstruction was made with Roux-en-Y biliary enteric anastomosis, the mean post operative stay was 9 days. The mean post operative survival of two patients undergoing surgery with curative intent was 21 months, in contrast to 10 months for the patient with palliative surgery. One patient is alive 22 months with no evidence of disease. Our results supports an aggressive surgical approach in patients with Klatskin tumor which should include Hepatectomy to obtain free resection margins.
通常起源于肝管汇合处的原发性癌（Klatskin瘤）在诊断时被视为不可切除，因此有人主张采用经皮或内镜放置支架的方法。不幸的是，采用这些姑息性治疗方式，中位生存期仅为3至6个月。然而，通过积极的肿瘤手术切除，已获得了17%的五年生存率。本文总结了我们对3例接受手术的Klatskin瘤患者的经验。这些Klatskin瘤分别为II型（1例）、IIIa型（1例）和IIIb型（1例）。II型肿瘤患者在肝门处进行了广泛的肿瘤切除和肝外胆管切除。III型肿瘤患者分别在肝门处进行了肝外胆管切除并联合左、右肝切除术。采用Roux-en-Y胆肠吻合术进行重建，术后平均住院时间为9天。两名接受根治性手术患者的术后平均生存期为21个月，而接受姑息性手术患者的生存期为10个月。1例患者存活22个月，无疾病迹象。我们的结果支持对Klatskin瘤患者采用积极的手术方法，其中应包括肝切除术以获得切缘阴性。
