关键词: 围肝门外科技术, 胆道外科, 第一肝门, 顺逆结合肝门解剖, 数字医学

Abstract:

Application of perihilar surgical techniques in biliary tract surgery        WANG Jian*, QUAN Zhi-wei. *Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127，China
Corresponding authors: WANG Jian, E-mail: dr_wangjian@126.com; QUAN Zhi-wei,E-mail: zhiwquan@163.com
Abstract    Perihilar biliary diseases have a wide spectrum of diseases including stones, inflammation, tumors, injuries and congenital malformations. Because of their characteristics such as anatomic variability, pathophysiological complexity, high operative difficulties, more postoperative complications and high operative risk, the perihilar biliary surgery is a high difficulty area in biliary surgery. For common clinical features, common surgical methods and common technical difficulties of perihilar biliary diseases, the perihilar surgical technique system adequately evaluates hilar anatomy and its variations, liver function and volume of residual liver relying on three-dimensional digital medical imaging technology, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, then re-evaluates the relationship between the lesion and the hepatic artery and portal vein, and ultimately sets the surgical procedure. It is developed to improve the R0 resection rate, quality of cholangiojejunostomy, quality of vascular resection and reconstruction and safety of operation, eventually for the purpose of reducing postoperative complication rate and perioperative mortality and improving the prognosis. So surgeons should pay attention to the comprehensive system involving multiple disciplines in order to improve the effectiveness and safety in diagnosis and treatment of perihilar biliary diseases.

Key words: perihilar surgical technique, biliary surgery, first porta hepatis, combining anterograde and retrograde route exposing hepatic hilum, digital medicine