摘要围肝门胆道肿瘤包括肝门部胆管癌、侵犯肝门的胆囊癌和侵犯肝门的肝内胆管癌,因其具有侵袭性强、解剖变异性大、病理生理复杂、生物学行为多样和术前评估困难等共同特点,导致R0根治性切除率低、围术期并发症率与病死率高、预后差.围肝门外科技术体系是以精准外科理念为指导,以肝门解剖与暴露为核心、以三维数字医学影像评估技术为手段,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,完全敞开肝门后充分显露病灶与肝动脉和门静脉之间的关系,从而制定合理的个体化手术方案.针对围肝门胆道肿瘤的诊治难点,应用围肝门外科技术体系,通过精准的术前评估、精密的手术规划、精确的术中再评估、精细的手术操作和精良的术后管理,提高围肝门胆道肿瘤可切除评估准确性、R0根治性切除率、手术的安全性和胆肠吻合的精准性,降低术后并发症率和围手术期病死率,改善围肝门胆道肿瘤预后.

abstractsPerihilar biliary tract tumours include hilar cholangiocarcinoma,gallbladder cancer invading the hepatic hilum and intrahepatic cholangiocarcioma invading the hepatic hilum.The tumours have the special characteristics such as strong invasion capability,the anatomic variant,the pathophysiological complexity,the biological behavior diversity and the difficulty of preoperative evaluation which result in low R0 resection rate,more postoperative complications,more mortality and poor prognosis.The perihilar surgical techniques system aims to set a reasonable and individual operation procedure on the principle of precision surgery by taking the key technique of hilar dissection and exposing,evaluting the hilar anatomy by the means of three-dimensional digital medical image evaluation system,evaluting the relationship between the tumour and hepatic artery and portal vein under the condition of hepatic hilum complete exposure by combining anterograde and retrograde route from intra and extra-hepatic direction to hepatic hilum.The perihilar surgical techniques system is applied to improve the accuracy of resectable evaluation,the R0 radical resection rate,the safety of operation and the accuracy of cholangiojejunostomy through the accurate preoperative evaluation,the detailed operation plan,the accurate intraoperative reassessment,the perfect operative procedure and the excellent postoperative management,eventually for the purpose of reducing the postoperative complications rate and perioperative mortality and improving the prognosis of perihilar biliary tract tumours.