肝门部胆管癌(hilar cholangiocarcinoma),又称Klaskin癌,是指起源于左右肝管、分叉部和肝总管上段胆管上皮的恶性肿瘤,约占胆管癌的60%~70%[1]。由于其临床表现隐匿,早期难以被发现。目前根治性手术是最有效的提高其生存率的治疗方式,随着肝门部胆管癌R0切除率的不断升高,5年生存率不断提高[2,3],但仍有不少问题有待于解决……
Citation: 何强,梁力建. Issues to Be Concerned in The Management of Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(11): 869-872. doi: Copy
1. | Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma [J]. Lancet, 2005; 366(9493): 1303-1314. |
2. | DeOliveira ML, Cunningham SC, Cameron JL, et al. Cho-langiocarcinoma: thirty-one-year experience with 564 patients at a single institution [J]. Ann Surg, 2007; 245(5): 755-762. |
3. | Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience [J]. Eur J Surg Oncol, 2008; 34(7): 787-794. |
4. | Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas [J]. J Hepatobiliary Pancreat Surg, 2008; 15(1): 25-30. |
5. | Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro) [J]. HPB (Oxford), 2008; 10(2): 130-133. |
6. | 陈东, 彭宝岗, 李绍强, 等. 肝门部胆管癌术前减黄临床价值 [J]. 中国实用外科杂志, 2007; 27(10): 805-808. |
7. | Yokoyama Y, Nagino M, Nishio H, et al. Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 447-454. |
8. | Komori K, Nagino M, Nimura Y. Hepatocyte morphology and kinetics after portal vein embolization [J]. Br J Surg, 2006; 93(6): 745-751. |
9. | Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up [J]. Ann Surg, 2006; 243(3): 364-372. |
10. | de Baère T, Roche A, Amenabar JM, et al. Liver abscess formation after local treatment of liver tumors [J]. Hepatology, 1996; 23(6): 1436-1440. |
11. | Doppman JL, Girton M, Vermess M. The risk of hepatic artery embolization in the presence of obstructive jaundice [J]. Radiology, 1982; 143(1): 37-43. |
12. | Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients [J]. Radiology, 2005; 234(2): 625-630. |
13. | Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [S]. 6th eds. Berlin Heidelberg-New York: Springer, 2002. |
14. | Nishio H, Nagino M, Oda K, et al. TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging sys [J]. Langenbecks Arch Surg, 2005; 390(4): 319-327. |
15. | Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [J]. Ann Surg, 1998; 228(3): 385-394. |
16. | Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [J]. Ann Surg, 2001; 234(4): 507-517. |
17. | Chen RF, Li ZH, Zhou JJ, et al. Preoperative evaluation with T-staging system for hilar cholangiocarcinoma [J]. World J Gastroenterol, 2007; 13(43): 5754-5759. |
18. | 彭承宏, 赵之明, 彭淑牖, 等. 用 T-分期系统回顾性分析 47例肝门部胆管癌 [J]. 中华外科杂志, 2005; 43 (1): 56-59. |
19. | Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence [J]. Ann Surg, 2008; 248(2): 273-279. |
20. | 赖佳明, 梁力建, 李绍强, 等. 手术切除治疗肝门部胆管癌 [J]. 中华肝胆外科杂志, 2006; 12(8): 509-511. |
21. | Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China [J]. Ann Surg Oncol, 2008; 15(8): 2113-2119. |
22. | Tsalis K, Vasiliadis K, Kalpakidis V, et al. A single-center experience in the management of Altemeier-Klatskin tumors [J]. J Gastrointestin Liver Dis, 2007; 16(4): 383-389. |
23. | 周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [J]. 中华外科杂志, 2006; 44(23): 1599-1603. |
24. | Ikeyama T, Nagino M, Oda K, et al. Surgical approach to bismuth Type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases [J]. Ann Surg, 2007; 246(6): 1052-1057. |
25. | Paik KY, Choi DW, Chung JC, et al. Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma [J]. J Gastrointest Surg, 2008; 12(7): 1268-1274. |
26. | van Gulik TM, Gouma DJ. Changing perspectives in the assessment of resectability of hilar cholangiocarcinoma [J]. Ann Surg Oncol, 2007; 14(7): 1969-1971. |
27. | Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma [J]. Am Surg, 2006; 72(7): 599-604. |
28. | Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? [J]. Surgery, 2007; 141(5): 581-588. |
29. | 韩风, 周进学, 张玲, 等. 肝叶切除联合门静脉切除和重建在肝门部胆管癌根治术中的应用 [J]. 中华外科杂志, 2007; 45(11): 763-765. |
30. | Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy [J]. Langenbecks Arch Surg, 2006; 391(3): 203-208. |
31. | Miyazaki M, Kimura F, Shimizu H, et al. Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 463-468. |
32. | 黄志强. 肝门部胆管癌外科治疗观念能否有所转变 [J]. 临床外科杂志, 2008; 16(1): 3-4. |
33. | Han SS, Jang JY, Lee KU, et al. Actual long-term outcome of Klatskin’s tumor after surgical resection [J]. Hepatogastroenterology, 2008; 55(88): 1986-1992. |
34. | 孙学军, 石景森, 何平, 等. 影响胆管癌切除术后的预后因素分析 [J]. 中国普外基础与临床杂志, 2006; 13(1): 85-88. |
35. | Nagino M, Kamiya J, Arai T, et al. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma [J]. Ann Surg, 2006; 243(1): 28-32. |
36. | Pinson CW, Rossi RL. Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer [J]. World J Surg, 1988; 12(1):52-59. |
37. | Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [J]. Ann Surg, 1992; 215(1): 31-38. |
38. | Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [J]. Ann Surg, 2001; 233(3): 385-392. |
39. | 蔡秀军, 沈波. 肝门部胆管癌术中淋巴结清扫 [J]. 中国实用外科杂志, 2007; 27(5): 366-367. |
40. | Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [J]. J Am Coll Surg, 2007; 204(2): 250-260. |
41. | Tojima Y, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma [J]. Ann Surg, 2003; 237(2): 201-207. |
42. | Jonas S, Benckert C, Thelen A, et al. Radical surgery for hilar cholangiocarcinoma [J]. Eur J Surg Oncol, 2008; 34(3): 263-271. |
43. | Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma [J]. Ann Surg, 2005; 242(3): 451-458. |
44. | Thelen A, Neuhaus P. Liver transplantation for hilar cholangiocarcinoma [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 469-475. |
- 1. Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma [J]. Lancet, 2005; 366(9493): 1303-1314.
- 2. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cho-langiocarcinoma: thirty-one-year experience with 564 patients at a single institution [J]. Ann Surg, 2007; 245(5): 755-762.
- 3. Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience [J]. Eur J Surg Oncol, 2008; 34(7): 787-794.
- 4. Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas [J]. J Hepatobiliary Pancreat Surg, 2008; 15(1): 25-30.
- 5. Nimura Y. Preoperative biliary drainage before resection for cholangiocarcinoma (Pro) [J]. HPB (Oxford), 2008; 10(2): 130-133.
- 6. 陈东, 彭宝岗, 李绍强, 等. 肝门部胆管癌术前减黄临床价值 [J]. 中国实用外科杂志, 2007; 27(10): 805-808.
- 7. Yokoyama Y, Nagino M, Nishio H, et al. Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 447-454.
- 8. Komori K, Nagino M, Nimura Y. Hepatocyte morphology and kinetics after portal vein embolization [J]. Br J Surg, 2006; 93(6): 745-751.
- 9. Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up [J]. Ann Surg, 2006; 243(3): 364-372.
- 10. de Baère T, Roche A, Amenabar JM, et al. Liver abscess formation after local treatment of liver tumors [J]. Hepatology, 1996; 23(6): 1436-1440.
- 11. Doppman JL, Girton M, Vermess M. The risk of hepatic artery embolization in the presence of obstructive jaundice [J]. Radiology, 1982; 143(1): 37-43.
- 12. Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients [J]. Radiology, 2005; 234(2): 625-630.
- 13. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [S]. 6th eds. Berlin Heidelberg-New York: Springer, 2002.
- 14. Nishio H, Nagino M, Oda K, et al. TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging sys [J]. Langenbecks Arch Surg, 2005; 390(4): 319-327.
- 15. Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system [J]. Ann Surg, 1998; 228(3): 385-394.
- 16. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [J]. Ann Surg, 2001; 234(4): 507-517.
- 17. Chen RF, Li ZH, Zhou JJ, et al. Preoperative evaluation with T-staging system for hilar cholangiocarcinoma [J]. World J Gastroenterol, 2007; 13(43): 5754-5759.
- 18. 彭承宏, 赵之明, 彭淑牖, 等. 用 T-分期系统回顾性分析 47例肝门部胆管癌 [J]. 中华外科杂志, 2005; 43 (1): 56-59.
- 19. Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence [J]. Ann Surg, 2008; 248(2): 273-279.
- 20. 赖佳明, 梁力建, 李绍强, 等. 手术切除治疗肝门部胆管癌 [J]. 中华肝胆外科杂志, 2006; 12(8): 509-511.
- 21. Yubin L, Chihua F, Zhixiang J, et al. Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China [J]. Ann Surg Oncol, 2008; 15(8): 2113-2119.
- 22. Tsalis K, Vasiliadis K, Kalpakidis V, et al. A single-center experience in the management of Altemeier-Klatskin tumors [J]. J Gastrointestin Liver Dis, 2007; 16(4): 383-389.
- 23. 周宁新, 黄志强, 张文智, 等. 402例肝门部胆管癌临床分型、手术方式与远期疗效的综合分析 [J]. 中华外科杂志, 2006; 44(23): 1599-1603.
- 24. Ikeyama T, Nagino M, Oda K, et al. Surgical approach to bismuth Type Ⅰ and Ⅱ hilar cholangiocarcinomas: audit of 54 consecutive cases [J]. Ann Surg, 2007; 246(6): 1052-1057.
- 25. Paik KY, Choi DW, Chung JC, et al. Improved survival following right trisectionectomy with caudate lobectomy without operative mortality: surgical treatment for hilar cholangiocarcinoma [J]. J Gastrointest Surg, 2008; 12(7): 1268-1274.
- 26. van Gulik TM, Gouma DJ. Changing perspectives in the assessment of resectability of hilar cholangiocarcinoma [J]. Ann Surg Oncol, 2007; 14(7): 1969-1971.
- 27. Hemming AW, Kim RD, Mekeel KL, et al. Portal vein resection for hilar cholangiocarcinoma [J]. Am Surg, 2006; 72(7): 599-604.
- 28. Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? [J]. Surgery, 2007; 141(5): 581-588.
- 29. 韩风, 周进学, 张玲, 等. 肝叶切除联合门静脉切除和重建在肝门部胆管癌根治术中的应用 [J]. 中华外科杂志, 2007; 45(11): 763-765.
- 30. Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy [J]. Langenbecks Arch Surg, 2006; 391(3): 203-208.
- 31. Miyazaki M, Kimura F, Shimizu H, et al. Recent advance in the treatment of hilar cholangiocarcinoma: hepatectomy with vascular resection [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 463-468.
- 32. 黄志强. 肝门部胆管癌外科治疗观念能否有所转变 [J]. 临床外科杂志, 2008; 16(1): 3-4.
- 33. Han SS, Jang JY, Lee KU, et al. Actual long-term outcome of Klatskin’s tumor after surgical resection [J]. Hepatogastroenterology, 2008; 55(88): 1986-1992.
- 34. 孙学军, 石景森, 何平, 等. 影响胆管癌切除术后的预后因素分析 [J]. 中国普外基础与临床杂志, 2006; 13(1): 85-88.
- 35. Nagino M, Kamiya J, Arai T, et al. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma [J]. Ann Surg, 2006; 243(1): 28-32.
- 36. Pinson CW, Rossi RL. Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer [J]. World J Surg, 1988; 12(1):52-59.
- 37. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [J]. Ann Surg, 1992; 215(1): 31-38.
- 38. Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection [J]. Ann Surg, 2001; 233(3): 385-392.
- 39. 蔡秀军, 沈波. 肝门部胆管癌术中淋巴结清扫 [J]. 中国实用外科杂志, 2007; 27(5): 366-367.
- 40. Baton O, Azoulay D, Adam DV, et al. Major hepatectomy for hilar cholangiocarcinoma type 3 and 4: prognostic factors and longterm outcomes [J]. J Am Coll Surg, 2007; 204(2): 250-260.
- 41. Tojima Y, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma [J]. Ann Surg, 2003; 237(2): 201-207.
- 42. Jonas S, Benckert C, Thelen A, et al. Radical surgery for hilar cholangiocarcinoma [J]. Eur J Surg Oncol, 2008; 34(3): 263-271.
- 43. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma [J]. Ann Surg, 2005; 242(3): 451-458.
- 44. Thelen A, Neuhaus P. Liver transplantation for hilar cholangiocarcinoma [J]. J Hepatobiliary Pancreat Surg, 2007; 14(5): 469-475.