Gazzaniga G M, Ciferri E, Bagarolo C, Filauro M, Bondanza G, Fazio S, Ermili F
First Department of General Surgery, San Martino Hospital, Genoa, Italy.
J Surg Oncol Suppl. 1993;3:140-6. doi: 10.1002/jso.2930530537.
One hundred ten cases of primitive hepatic hilum neoplasms (Klatskin tumor) observed from January 1970 to June 1992 are reviewed and the variations occurring in the diagnostic back-up and treatment policy are considered. The importance of careful preoperative staging is stressed. Preoperative tests should be limited to investigations supplying most informations about endo- and esobiliary diffusion of the tumoral mass (ultrasound, direct cholangiography, portography). This paper demonstrates that a surgical approach with both palliative or resective aims is suitable for all patients with no local or general contraindications. Other cases are treated with percutaneous or endoscopic biliary stenting. The authors conclude by pointing out that tumoral resection with biliodigestive anastomosis is in any case the treatment of choice in these patients as it gives a better quality of life (improved "comfort index").
回顾了1970年1月至1992年6月间观察到的110例原发性肝门部肿瘤（克氏瘤），并考虑了诊断支持和治疗策略中出现的变化。强调了术前仔细分期的重要性。术前检查应限于能提供有关肿瘤肿块肝内和肝外胆管扩散的最多信息的检查（超声、直接胆管造影、门静脉造影）。本文表明，对于没有局部或全身禁忌证的所有患者，采用姑息性或根治性目的的手术方法都是合适的。其他病例采用经皮或内镜下胆管支架置入术治疗。作者最后指出，无论如何，肿瘤切除并进行胆肠吻合术是这些患者的首选治疗方法，因为它能提供更好的生活质量（提高“舒适度指数”）。
