肝门部胆管癌外科治疗的争议与进展

肝门部胆管癌（HCCA）主要发生在肝总管和左右肝管及其汇合部，其约占胆管癌的50.0%～70.0%，是胆道系统常见的恶性肿瘤，且其发病率亚洲最高。目前，手术是治疗HCCA的唯一有效途径。HCCA因早期症状缺乏或不典型，往往患者出现黄疸或者明显腹痛等临床症状，已到进展期才能明确诊断，且其解剖位置特殊、复杂，肿瘤具有沿胆管生长及浸润性生长的生物学特性，其根治性手术切除率及长期生存率均较低。HCCA的外科治疗已取得了较大的进展，但仍然是外科医生所面临的挑战之一。在外科治疗方面，目前还存在许多争议，新的争议点也在不断出现，譬如是否需要实施术前胆道引流及方式、剩余肝体积不足的解决、肝切除的范围、淋巴清扫范围、联合血管切除及肝移植的价值、微创手术应用等。笔者基于当前最新发表文献探讨这些争议，以期对HCCA正确认识和理解，规范化HCCA的治疗，改善患者预后。

Controversies and advances in surgical treatment of hilar cholangiocarcinoma

Hilar cholangiocarcinoma (HCCA) mainly occurs in the common hepatic duct, left and right hepatic duct, and their confluence, accounting for approximately 50.0% to 70.0% of all cholangiocarcinoma. It is a common malignant tumor of the biliary system, with the highest incidence in Asia. Currently, surgery is the only effective treatment for HCCA. Due to the lack of early or typical symptoms, patients often present with jaundice or significant abdominal pain, and the diagnosis is usually confirmed only when the disease has progressed. Additionally, the anatomical location of HCCA is special and complex, and the tumor exhibits biological characteristics of growth along the bile ducts and infiltrative growth. Therefore, the rates of radical surgical resection and long-term survival are relatively low. Surgical treatment of HCCA has made significant progress, but it remains a challenge for surgeons. There are still many controversies in surgical treatment, with new points of contention continually emerging, such as the necessity and methods of preoperative biliary drainage, solutions for inadequate remnant liver volume, the extent of liver resection, the scope of lymph node dissection, the value of combined vascular resection and liver transplantation, and application of minimally invasive surgery. The authors discuss these controversies based on the most recent literature, aiming to promote a correct understanding of HCCA, standardize its treatment, and improve patient prognosis.