Gazzaniga G M, Filauro M, Bagarolo C, Ciferri E, Bondanza G
1st Dept. of General Surgery, Civil Hospital, San Martino, Genova, Italy.
Hepatogastroenterology. 1993 Jun;40(3):244-8.
A series of one hundred cases of primitive tumors of the biliary confluence (Klatskin tumor) observed between 1970 and 1990 are reviewed with respect to the variations occurring in the diagnostic backup and treatment policy. The need for peroperative staging is noted: On the basis of their clinical experience, the authors restricted the preoperative study to those investigations providing more information about endo- and exobiliary diffusion of tumoral mass (ultrasound, direct cholangiography). The review demonstrates the possibilities of a surgical approach to a palliative or resectional treatment in all patients in whom no local or general contraindications are present. Other cases are treated with percutaneous or endoscopic biliary stenting. The authors conclude that tumor resection with bilio-digestive anastomosis is the treatment of choice in selected patients, and results in a better quality of life with an improved "comfort index".
回顾了1970年至1990年间观察到的100例肝门部原发性肿瘤（克氏壶腹肿瘤）病例，以了解诊断支持和治疗策略方面发生的变化。指出了术中分期的必要性：基于临床经验，作者将术前研究限制在那些能提供更多关于肿瘤块在肝内外扩散信息的检查（超声、直接胆管造影）。该综述表明，在没有局部或全身禁忌证的所有患者中，采用手术方法进行姑息性或根治性治疗是可行的。其他病例则采用经皮或内镜胆管支架置入术治疗。作者得出结论，在选定的患者中，行胆肠吻合的肿瘤切除术是首选治疗方法，可改善生活质量并提高“舒适度指数”。
