肝内胆管癌手术指征与术式选择

虽然肝内胆管癌(ICC)在原发性肝癌中仅占10%~15%,但ICC相对于肝细胞癌诊断率低、进展更快,有着更高的致死率,加之ICC发病率逐年增加,引起越来越多肝胆外科医生的重视。外科切除仍是目前公认的惟一能治愈ICC的方法。手术治疗的技术和方法较过去相比有了长足进步,但有关ICC的手术指征和术式选择的问题一直是临床医生争论的焦点。在病人身体状况允许的条件下,如果剩余肝体积足够且无远处转移者,应积极采取手术切除治疗。术式推荐解剖性肝切除联合清扫区域淋巴结(至少6枚淋巴结),对于原发性孤立性ICC病人为保留肝实质可以考虑非解剖切除,但要保证阴性切缘,必要时联合胆管切除、胆肠吻合内引流和胰十二指肠切除等。微创手术有一定优势但仍需要慎重考虑,对于有高转移风险的病人可以先行诊断性腹腔镜探查,以评估根治手术的可行性。同时兼顾多学科优势,重视个体化的综合治疗方案。

Surgical indication and options for intrahepatic cholangiocarcinoma

Surgical indication and options for intrahepatic cholangiocarcinoma DAI Chao-liu，JU Ming-guang. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author：DAI Chao-liu，E-mail：daicl@sj-hospital.org
Abstract Although intrahepatic cholangiocarcinoma（ICC）accounts for only 10% to 15% in primary liver cancer，it has a lower diagnostic rate，faster progression，higher mortality rate and the incidence rate，which has attracted more and more attention from doctors of hepatobiliary surgery. Complete resection is still the only way to cure ICC. Compared with the past，the technique and method of surgical treatment have made great progress，but the problem about the indication and the surgical options of ICC has always been the focus of debate among clinicians. It is suggested that if the future liver remnant is enough and there is no distant metastasis，active surgical therapy should be taken. For the surgical options，it is recommended for anatomic hepatectomy combined with dissection of at least 6 lymph nodes. For the patients with primary isolated ICC，nonanatomic hepatectomy can be considered to preserve the liver parenchyma，but to ensure the negative margin. Combine with bile duct resection，internal drainage by Roux-en-Y and pancreaticoduodenectomy if necessary. Minimally invasive surgery has some advantages，but it still needs to be considered carefully. For patients with a high risk of metastasis，diagnostic laparoscopic surgery can be used to ensure the feasibility of radical surgery. At the same time，surgeons should take into account the advantages of multidisciplines and attach importance to the individual comprehensive treatment plan.