摘要肝门部胆管癌亦称胆管上段癌、围肝门部胆管癌、Klatskin瘤等.Bismuth-CorletteⅢ型肝门部胆管癌指肿瘤侵犯右肝管(Ⅲa)或左肝管(Ⅲb),Bismuth-CorletteⅣ型肝门部胆管癌指左右肝内胆管均已受侵犯.在严格把握手术指征的前提下,经过充分的术前管理,Bismuth-CorletteⅢ、Ⅳ型肝门部胆管癌扩大肝切除是一种安全可行的手术方式.在进行扩大肝切除同时,应视情况积极选择右半肝切除和联合尾状叶切除.同时应常规施行肝十二指肠韧带淋巴结骨骼化清扫,并视情况扩大至腹腔干、主动脉旁及胰头后方.在能够根治性切除的前提下,应切除受侵犯血管,并视情况对所切除血管积极进行重建.

abstractsHilar cholangiocarcinoma (HCCA) is also known as cancer at the upper part of bile duct,perihilar cholangiocarcinoma or Klatskin tumor,etc.Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma refers to tumor invading right hepatic duct (Ⅲa) or left hepatic duct (Ⅲb).While Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma refers to both left and right intrahepatic bile ducts being invaded.Under the premise of strictly grasping the indications of surgery,if preoperative management is conducted carefully,extended hepatic resection is a safe and feasible surgery to remove Bismuth-Corlette type Ⅲ and type Ⅳ hilar cholangiocarcinoma.When conducting extended hepatic resection,right hepatectomy and combined caudate lobectomy should be conducted depending on the circumstances.Routine skeletization lymph node dissection of the hepatoduodenal ligament is performed,which could be expanded into celiac trunk,para-aortic area and the rear of pancreatic head.In the premise of radical resection,invaded vessels should be removed and then reconstructed depending on circumstances.