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

摘要：

围肝门胆道疾病涵盖结石、炎症、肿瘤、损伤和先天性畸形5大类胆道疾病，具有疾病谱广，解剖变异大，病理生理复杂，手术难度大、并发症多、风险高等特点，是胆道外科的高难领域。围肝门外科技术体系针对围肝门胆道疾病的共性临床特征、共性手术方式和共性技术难点，依托三维数字医学影像学技术，在充分评估肝门解剖与变异、肝功能与残肝体积的基础上，通过由肝外向肝门和由肝内向肝门顺逆结合的肝门解剖路径，完全敞开肝门后，再次评估病灶与肝动脉和门静脉的关系，制定最终的手术方案，能最大限度地提高R0切除率、胆肠吻合的质量、血管切除重建的质量和手术安全性，降低并发症发生率和围手术期病死率，延长病人生存时间。重视这一涉及多学科的综合体系，有助于提高围肝门胆道疾病诊疗的有效性与安全性。

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