Jonas S, Kling N, Guckelberger O, Keck H, Bechstein W O, Neuhaus P
Chirurgische Klinik, Virchow Klinikum der Humboldt Universität, Berlin, Germany.
Transpl Int. 1998;11 Suppl 1:S206-8. doi: 10.1007/s001470050462.
Although the surgical treatment of hilar cholangiocarcinoma represents the only potentially curative option, survival figures remain low over the long term. After hilar and partial hepatic resections for hilar cholangiocarcinoma, loco-regional tumor recurrence appears as the primary site of failure. From April 1992 to April 1996, 14 patients underwent extended bile duct resections. Extended bile duct resections combine total hepatectomy, partial pancreatoduodenectomy, and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament. The postoperative 60-day mortality rate was 14% (n = 2). The rate of curative resections was 93% (13 of 14 extended bile duct resections). One- and 4-year survival rates after curative resections were 56% and 30%, respectively. The rate of curative resections increased by combining total hepatectomy, partial pancreatoduodenectomy, and liver transplantation, i.e., extended bile duct resection. However, survival figures have not improved accordingly. Therefore, this extended surgical procedure has to be implemented with caution and possibly not without modifications (e.g., multimodal treatment).
尽管肝门部胆管癌的手术治疗是唯一可能治愈的选择，但长期生存率仍然很低。在对肝门部胆管癌进行肝门部及部分肝切除术后，局部区域肿瘤复发是主要的失败部位。1992年4月至1996年4月，14例患者接受了扩大胆管切除术。扩大胆管切除术结合了全肝切除术、部分胰十二指肠切除术和肝移植术，试图在不解剖肝十二指肠韧带的情况下根除整个胆道系统。术后60天死亡率为14%（n = 2）。根治性切除率为93%（14例扩大胆管切除术中的13例）。根治性切除术后1年和4年生存率分别为56%和30%。通过结合全肝切除术、部分胰十二指肠切除术和肝移植术，即扩大胆管切除术，根治性切除率有所提高。然而，生存率并没有相应提高。因此，这种扩大的手术程序必须谨慎实施，可能还需要进行修改（例如多模式治疗）。
