关键词: 肝门部胆管癌, 外科治疗, 诊疗路径, 肝储备功能, 计划性肝切除

Abstract: Difficulties and controversies in the surgical treatment of hilar cholangiocarcinoma and the treatment experience of Jiang's team in 23 years        LI Bin, JIANG Xiao-qing.Department of Biliary Tract I, the Third Affiliated Hospital of Naval Medical University (Shanghai Oriental Hepatobiliary Surgery Hospital), Shanghai 200438, China
Corresponding author: JIANG Xiao-qing, E-mail:jxq122@VIP.sina.cn
Abstract    Surgical treatment is still the most effective treatment modality for hilar cholangiocarcinoma, and a reasonable and safe surgical treatment plan involves several core aspects, such as tumor resectability assessment, hepatic reserve function assessment, preoperative preparation, surgical operation, and postoperative complication management. Accurate classification and differential diagnosis of hilar region tumors, reasonable preoperative biliary drainage plan, the reasonable scope of hepatic resection, and the necessity of revascularization after hepatic artery resection are important issues affecting the outcome of hilar cholangiocarcinoma. There are many differences in the pathological types, molecular characteristics, biological behaviors, and lymph node metastasis pathways of different types of perihilar cholangiocarcinoma. It is necessary to make a strict distinction to formulate reasonable clinical decisions and treatment plans. PTBD is more conducive to adequate biliary drainage, but there is also a risk of tumor cell spread and metastasis. It is recommended that for planned combined hepatectomy above semi-liver, PTBD should be the first choice for unilateral drainage of the planned preserved liver lobe, and the importance of preoperative bile reflux in accelerating liver function recovery should be emphasized. Combined resection of semi-liver and above can increase the R0 resection rate and survival rate, but the biological characteristics of the tumor and the impact of surgical trauma should also be considered. Different surgical plans should be selected according to the tumor type and stage to achieve the goal of reasonably controlling surgical injury and maximizing therapeutic benefits. Retaining or reconstructing the arterial blood supply of the residual liver lobe is of great significance for preventing postoperative liver failure. Preoperative three-dimensional reconstruction has important value in planning surgical plans.

Key words: hilar cholangiocarcinoma, surgical treatment, diagnosis and treatment pathway, hepatic reserve function, planned hepatectomy