• 第三軍醫(yī)大學(xué)西南醫(yī)院肝膽外科中心(重慶400038);

目的  提高肝門部膽管癌的治愈切除率。
方法  收集近期有關(guān)肝門部膽管癌手術(shù)治療的文獻(xiàn)資料。
結(jié)果  ①早期診斷； ②了解肝門部膽管癌向肝側(cè)的浸潤(rùn)情況； ③合理的切除治療； ④合并的血管切除； ⑤減少術(shù)后并發(fā)癥等是有效的措施。
結(jié)論  提高肝門部膽管癌切除的遠(yuǎn)期療效是可能的。

引用本文： 何振平. 肝門部膽管癌的手術(shù)治療進(jìn)展. 中國(guó)普外基礎(chǔ)與臨床雜志, 2000, 7(2): 128-130. doi: 復(fù)制

1. Hann LE, Greatrex KV, Bach AM, et al. Cholangiocarcinoma at the hepatic hilus: sonographic findings 〔Ｊ〕. AJR, 1997; 168(4)∶985.
2. Hann LE, Fong Y, Shriver CD, et al. Malignant hepatic hilar tumor: can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability? 〔Ｊ〕 J Ultrasound Med, 1996; 15(1)∶37.
3. Hall JK, Choi BI, Kim TK, et al. Hilar cholangiocarcinoma. Thinsection spiral CT findings with cholangiography correlation 〔Ｊ〕. Radiographics, 1997; 17(6)∶1475.
4. Tillich M, Mischinger HJ, Preisegger KH, et al. Multiphasic helical CT in diagnosis and staging of hilar cholangiocarcinoma 〔Ｊ〕. AJR, 1998; 171(3)∶651.
5. Kusano T, Shimabukuro M, Tamai O, et al. The use of intraoperative ultrasonography, for detecting tumor extension in bile duct carcinoma 〔Ｊ〕. Int Surg, 1997; 82(1)∶44.
6. Satanapa P, Hargrove NS, Sirivatanauksorn Y, et al. The potential role of intraoperative ultrasonography in the surgical treatment of hilar cholangiocarcinoma 〔Ｊ〕. HPB Surg, 1996; 9(2)∶93.
7. Satamato E, Nimura Y, Hayakawa, et al. The pattern of infiltration at the proximal horder of hilar bile duct carcinoma: a histologic analysis of 62 resected cases 〔Ｊ〕. Ann Surg, 1998; 227(3)∶405.
8. 鈴木英明. 肝門部近傍にぉけるグリソン系脈管群四相關(guān)と異常肝膽道外科の立場(chǎng)から 〔Ｊ〕. 日外寶函， 1982； 51(5)∶731.
9. Tashiro S, Tsuzi T, Kanemitsu K, et al. Prolongation of survival for carcinoma at the hepatic duct confluence 〔Ｊ〕. Surg, 1993; 113(2)∶270.
10. Tsuzuki T, Ueda M, Kuramochi S, et al. Carcinoma of the main hepatic duct junction: indication operative morbidity and mortality, and long term survival 〔Ｊ〕. Surg, 1990; 108(3)∶495.
11. Nagino M, Nimura Y, Kamiya J, et al. Segmental liver resection for hilar cholangiocarcinoma 〔Ｊ〕. HGE, 1998; 45(19)∶7.
12. Bhuiya MM, Mimura Y, Kato M, et al. Resection of intrahepatic bile duct carcinoma with hilar bile duct and portal vein invasiona case report 〔Ｊ〕. HGE, 1990; 27(4)∶421.
13. Miyazaki M, Ito H, Nakagawa, et al. Segment Ⅰ and Ⅳ resection as a new approach for hepatic hilar cholangiocarcinoma 〔Ｊ〕. Am J Surg, 1998; 175(3)∶229.
14. Becrurts KT, Hscher AH, Baurer TH, et al. Malignant tumor of the hepatic bifurcationresults of surgical therapy and prognostic factors 〔Ｊ〕. Chirurg, 1997; 68(4)∶378.
15. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus 〔Ｊ〕. World J Surg, 1990; 14∶535.
16. Miyazaki M, Ito H, Nakagawa, et al. Aggressive surgical approaches to hilar cholangiocarcinoma, hepatic or local, resection 〔Ｊ〕. Surg, 1998; 127(2)∶131.
17. Burke EC, Tarnagin WR, Hochwald SN, et al. Hilar cholangiocarcinoma, patterns of spread the importance of hepatic resection for curative operation, and a presargical clinical staging system 〔Ｊ〕. Ann Surg, 1998; 228(3)∶385.
18. Ogura Y, Kawarada Y. Surgical Strategies for carcinoma of the hepatic duct confluence 〔Ｊ〕. Br J Surg, 1998; 85(1)∶20.
19. 吉川達(dá)也. 膽道癌と血管外科 〔Ｊ〕. 手術(shù)， 1994；48∶31.
20. 草野敏臣， 白石佑之， 武藤良弘. 肝動(dòng)脈合并切除損傷后の再建法，主として胃大綱動(dòng)脈を用した再建手術(shù)， 1996； 50(10)∶1747.
21. 宮崎勝， 伊藤博， 中川宏治， 他. 外科的見(jiàn)地ガらみた肝內(nèi)側(cè)區(qū)域S4切除(S1+S4切除) 〔Ｊ〕. 膽と胰， 1998； 19(9)∶759.
22. 宮崎勝， 伊藤博， 海保隆ほか. 肝門部膽管癌血管合并切除術(shù)ぉとびQOL走考慮した尾狀葉全切除の意義と問(wèn)題點(diǎn) 〔Ｊ〕. 膽と胰， 1992； 13(8)∶123.
23. Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality and survival after resection for hilar cholangiocarcinoma 〔Ｊ〕. Ann Surg, 1996; 223(4)∶384.
24. klempnauer J, Ridder GJ, Von Vasielewski R, et al. Resectional surgery of hilar cholangiocarcinoma, a multivariation analysis of prognostic factors 〔Ｊ〕. J Clin Oncol, 1997; 15(2)∶947.
25. Mizuno S, Nimura Y, Suzuki H, et al. Portal vein branch occlusion induces cell proliferation of cholestatic rat liver 〔Ｊ〕. J Surg Res, 1996; 60(1)∶249.
26. Vogl TJ, Balzer JO, Dette K, et al. Initially unresectable hilar cholangiocarcinoma: hepatic regeneration after transarterial embolization 〔Ｊ〕. Radilogy, 1998; 208(1)∶217.
27. Nimura Y, Vesaka K, Nagino M, et al. Changes in hepatic lober function after with portal vein embolization an appraisal by biliary indocyanine green exeretion 〔Ｊ〕. Ann Surg, 1996; 223(1)∶77.
28. Baere T, Roche A, Elias D, et al. Preoperative portal vein embolization for extension of hepatectomy indication 〔Ｊ〕. Hepatology, 1996; 24(6)∶1386.
29. Ellias D, Debaere T, Roche A, et al. Preoperative selective portal vein embolization are an effective means of extending the indications of major hepatectomy in the normal and injured liver 〔Ｊ〕. HGE, 1998; 45(19)∶170.
30. Yamakado K, Takeda K, Matsumura K, et al. Regeneration of the unembolized liver parenchyma following portal. Vein embolization 〔Ｊ〕. J Hepatatol, 1997; 27(5)∶871.
31. Harada H, Imamura H, Miyagawa, et al. Fate of the human liver after hemihepatic portal vein embolization: cell kinetic and morphometric study 〔Ｊ〕. Hepatology, 1997; 26(5)∶1162.
  1. 1. Hann LE, Greatrex KV, Bach AM, et al. Cholangiocarcinoma at the hepatic hilus: sonographic findings 〔Ｊ〕. AJR, 1997; 168(4)∶985.
  2. 2. Hann LE, Fong Y, Shriver CD, et al. Malignant hepatic hilar tumor: can ultrasonography be used as an alternative to angiography with CT arterial portography for determination of resectability? 〔Ｊ〕 J Ultrasound Med, 1996; 15(1)∶37.
  3. 3. Hall JK, Choi BI, Kim TK, et al. Hilar cholangiocarcinoma. Thinsection spiral CT findings with cholangiography correlation 〔Ｊ〕. Radiographics, 1997; 17(6)∶1475.
  4. 4. Tillich M, Mischinger HJ, Preisegger KH, et al. Multiphasic helical CT in diagnosis and staging of hilar cholangiocarcinoma 〔Ｊ〕. AJR, 1998; 171(3)∶651.
  5. 5. Kusano T, Shimabukuro M, Tamai O, et al. The use of intraoperative ultrasonography, for detecting tumor extension in bile duct carcinoma 〔Ｊ〕. Int Surg, 1997; 82(1)∶44.
  6. 6. Satanapa P, Hargrove NS, Sirivatanauksorn Y, et al. The potential role of intraoperative ultrasonography in the surgical treatment of hilar cholangiocarcinoma 〔Ｊ〕. HPB Surg, 1996; 9(2)∶93.
  7. 7. Satamato E, Nimura Y, Hayakawa, et al. The pattern of infiltration at the proximal horder of hilar bile duct carcinoma: a histologic analysis of 62 resected cases 〔Ｊ〕. Ann Surg, 1998; 227(3)∶405.
  8. 8. 鈴木英明. 肝門部近傍にぉけるグリソン系脈管群四相關(guān)と異常肝膽道外科の立場(chǎng)から 〔Ｊ〕. 日外寶函， 1982； 51(5)∶731.
  9. 9. Tashiro S, Tsuzi T, Kanemitsu K, et al. Prolongation of survival for carcinoma at the hepatic duct confluence 〔Ｊ〕. Surg, 1993; 113(2)∶270.
  10. 10. Tsuzuki T, Ueda M, Kuramochi S, et al. Carcinoma of the main hepatic duct junction: indication operative morbidity and mortality, and long term survival 〔Ｊ〕. Surg, 1990; 108(3)∶495.
  11. 11. Nagino M, Nimura Y, Kamiya J, et al. Segmental liver resection for hilar cholangiocarcinoma 〔Ｊ〕. HGE, 1998; 45(19)∶7.
  12. 12. Bhuiya MM, Mimura Y, Kato M, et al. Resection of intrahepatic bile duct carcinoma with hilar bile duct and portal vein invasiona case report 〔Ｊ〕. HGE, 1990; 27(4)∶421.
  13. 13. Miyazaki M, Ito H, Nakagawa, et al. Segment Ⅰ and Ⅳ resection as a new approach for hepatic hilar cholangiocarcinoma 〔Ｊ〕. Am J Surg, 1998; 175(3)∶229.
  14. 14. Becrurts KT, Hscher AH, Baurer TH, et al. Malignant tumor of the hepatic bifurcationresults of surgical therapy and prognostic factors 〔Ｊ〕. Chirurg, 1997; 68(4)∶378.
  15. 15. Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus 〔Ｊ〕. World J Surg, 1990; 14∶535.
  16. 16. Miyazaki M, Ito H, Nakagawa, et al. Aggressive surgical approaches to hilar cholangiocarcinoma, hepatic or local, resection 〔Ｊ〕. Surg, 1998; 127(2)∶131.
  17. 17. Burke EC, Tarnagin WR, Hochwald SN, et al. Hilar cholangiocarcinoma, patterns of spread the importance of hepatic resection for curative operation, and a presargical clinical staging system 〔Ｊ〕. Ann Surg, 1998; 228(3)∶385.
  18. 18. Ogura Y, Kawarada Y. Surgical Strategies for carcinoma of the hepatic duct confluence 〔Ｊ〕. Br J Surg, 1998; 85(1)∶20.
  19. 19. 吉川達(dá)也. 膽道癌と血管外科 〔Ｊ〕. 手術(shù)， 1994；48∶31.
  20. 20. 草野敏臣， 白石佑之， 武藤良弘. 肝動(dòng)脈合并切除損傷后の再建法，主として胃大綱動(dòng)脈を用した再建手術(shù)， 1996； 50(10)∶1747.
  21. 21. 宮崎勝， 伊藤博， 中川宏治， 他. 外科的見(jiàn)地ガらみた肝內(nèi)側(cè)區(qū)域S4切除(S1+S4切除) 〔Ｊ〕. 膽と胰， 1998； 19(9)∶759.
  22. 22. 宮崎勝， 伊藤博， 海保隆ほか. 肝門部膽管癌血管合并切除術(shù)ぉとびQOL走考慮した尾狀葉全切除の意義と問(wèn)題點(diǎn) 〔Ｊ〕. 膽と胰， 1992； 13(8)∶123.
  23. 23. Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality and survival after resection for hilar cholangiocarcinoma 〔Ｊ〕. Ann Surg, 1996; 223(4)∶384.
  24. 24. klempnauer J, Ridder GJ, Von Vasielewski R, et al. Resectional surgery of hilar cholangiocarcinoma, a multivariation analysis of prognostic factors 〔Ｊ〕. J Clin Oncol, 1997; 15(2)∶947.
  25. 25. Mizuno S, Nimura Y, Suzuki H, et al. Portal vein branch occlusion induces cell proliferation of cholestatic rat liver 〔Ｊ〕. J Surg Res, 1996; 60(1)∶249.
  26. 26. Vogl TJ, Balzer JO, Dette K, et al. Initially unresectable hilar cholangiocarcinoma: hepatic regeneration after transarterial embolization 〔Ｊ〕. Radilogy, 1998; 208(1)∶217.
  27. 27. Nimura Y, Vesaka K, Nagino M, et al. Changes in hepatic lober function after with portal vein embolization an appraisal by biliary indocyanine green exeretion 〔Ｊ〕. Ann Surg, 1996; 223(1)∶77.
  28. 28. Baere T, Roche A, Elias D, et al. Preoperative portal vein embolization for extension of hepatectomy indication 〔Ｊ〕. Hepatology, 1996; 24(6)∶1386.
  29. 29. Ellias D, Debaere T, Roche A, et al. Preoperative selective portal vein embolization are an effective means of extending the indications of major hepatectomy in the normal and injured liver 〔Ｊ〕. HGE, 1998; 45(19)∶170.
  30. 30. Yamakado K, Takeda K, Matsumura K, et al. Regeneration of the unembolized liver parenchyma following portal. Vein embolization 〔Ｊ〕. J Hepatatol, 1997; 27(5)∶871.
  31. 31. Harada H, Imamura H, Miyagawa, et al. Fate of the human liver after hemihepatic portal vein embolization: cell kinetic and morphometric study 〔Ｊ〕. Hepatology, 1997; 26(5)∶1162.