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陈 炜,王 坚
Abstract:
Application of perihilar surgical techniques in intrahepatic cholangiocarcinoma invading hepatic hilum CHEN Wei, WANG Jian. Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China Corresponding author: WANG Jian, E-mail: dr_wangjian@126.com Abstract Intrahepatic cholangiocarcinoma invading hepatic hilum has the biological characteristics and clinical features of both gallbladder cancer and hilar cholangiocarcinoma, and it also combines the pathophysiological changes of liver disease. There are a series of therapeutic difficulties such as difficult exposure of three hepatic hilum, complexity of liver resection, difficult treatment of combined liver diseases and insensitivity to radiotherapy and chemotherapy, which result in low radical resection rate, difficulty in operation, high operative risk and poor prognosis. The perihilar surgical technique system based on special clinical features, surgical methods and pathophysiological characteristics, evaluates the tumor resectability, the anatomy structure of three hepatic hilum and the reserved liver function comprehensively and accurately before surgery, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, combined with accurate liver resection, accurate and high-quality biliary anastomosis and management of postoperative complication, which can improve surgical radicalization and safety, reduce surgical risk and postoperative complication rate, thereby improve the overall survival time of patients .
Key words: intrahepatic cholangiocarcinoma, perihilar surgical technique, combining anterograde and retrograde route exposing hepatic hilum, digital medicine
摘要:
侵犯肝门的肝内胆管癌兼有肝门部胆管癌和胆囊癌的临床特点与生物学特性,又合并肝脏基础疾病的病理生理学改变,具有三个肝门解剖艰难、肝脏切除复杂、肝脏合并病变处理困难、对放化疗不敏感等治疗难点,导致根治性切除率低,手术难度大、风险高和预后差。围肝门外科技术体系针对其特殊的临床特点、手术方式和病理生理学特征,通过术前全面、精确的肿瘤可切除性评估和三个肝门解剖的评估,以及保留侧肝功能的评估,采用顺逆结合的肝门显露路径、精准切肝技术、精确高质量的胆肠吻合和预估与管控并发症等措施,提高手术根治性与安全性,降低手术风险与并发症发生率,从而提高病人的总体生存时间。
关键词: , 肝内胆管癌, 围肝门外科技术, 顺逆结合肝门解剖路径, 数字医学
陈 炜,王 坚. 围肝门外科技术治疗侵犯肝门的肝内胆管癌[J]. 中国实用外科杂志, DOI: 10.19538/j.cjps.issn1005-2208.2019.02.08.
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URL: https://www.zgsyz.com/zgsywk/EN/10.19538/j.cjps.issn1005-2208.2019.02.08
https://www.zgsyz.com/zgsywk/EN/Y2019/V39/I02/134