Clinical Implications of Biliary Confluence Pattern for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma Applied to Hemihepatectomy
Clinical Implications of Biliary Confluence Pattern for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma Applied to Hemihepatectomy
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DOI：
10.1007/s11605-017-3377-2
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发表时间：
2017-04-01
影响因子：
3.2
通讯作者：
Li, Xiang-cheng
中科院分区：
文献类型：
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作者：
Ji, Gu-wei;Zhu, Fei-peng;Li, Xiang-cheng
由于胆道变异是常见的，我们的目的是澄清这些潜在的变化，并讨论其病理学意义的铋-科莱特（BC）IV型肝门胆管癌（HC）应用半肝切除术。正常胆管汇合模式定义为外周IV段胆管（B4）连接II段（B2）和III段（B3）胆管的共同干，形成左肝管（LHD），然后连接右肝管（RHD）。分别测量肝细胞左、右二级胆管分支至左门静脉脐部右侧（R1-L）和右门静脉头腹侧（Rr-R）的长度，并与肝细胞可切除胆管长度进行比较。比较不同BC类型的手术病理结果，IV型肿瘤右半肝切除术的可切除胆管长度明显长于正常胆管构型的Rl-L长度（分别为17.4 +/- 1.8和10.3 +/- 3.4 mm，p < 0.001），III型变异（B2连接B3和B4的共同主干）是主要构型（53.8%）。左半肝切除术根除IV型肿瘤的可切除长度与RHD缺失病例的Rr-R长度相当（分别为15.2 ± 2.5和16.4 ± 2.6 mm，p = 0.177），但明显长于正常构型（p < 0.001）。不可切除病例的估计长度为8.5 ± 2.0 mm。除淋巴结转移率外，III型和IV型肿瘤之间无显著差异（分别为29.7%和76.0%，p < 0.001）。考虑到有利的胆道变异，半肝切除术可能被选择用于BC IV型肿瘤的根治性切除，而对于可切除的胆管长度小于10 mm的患者，建议进行解剖性三段切除术。进一步研究验证。
Since biliary variations are commonly seen, our aims are to clarify these insidious variations and discuss their surgicopathologic implications for Bismuth-Corlette (BC) type IV hilar cholangiocarcinoma (HC) applied to hemihepatectomy.Three-dimensional images of patients with distal bile duct obstruction (n = 97) and advanced HC (n = 79) were reconstructed and analyzed retrospectively. Normal biliary confluence pattern was defined as the peripheral segment IV duct (B4) joining the common trunk of segment II (B2) and segment III (B3) ducts to form the left hepatic duct (LHD) that then joined the right hepatic duct (RHD). The lengths from left and right secondary biliary ramifications to the right side of the umbilical portion of the left portal vein (Rl-L) and the cranio-ventral side of the right portal vein (Rr-R) were measured, respectively, and compared with the resectable bile duct length in HCs. Surgicopathologic findings were compared between different BC types.The resectable bile duct length in right hemihepatectomy for eradication of type IV tumors was significantly longer than the Rl-L length in normal biliary configuration (17.4 +/- 1.8 and 10.3 +/- 3.4 mm, respectively, p < 0.001), and type III variation (B2 joining the common trunk of B3 and B4) was the predominant configuration (53.8%). The resectable length in left hemihepatectomy for eradication of type IV tumors was comparable with the Rr-R length in RHD absent cases (15.2 +/- 2.5 and 16.4 +/- 2.6 mm, respectively, p = 0.177) but significantly longer than that in normal configuration (p < 0.001). The estimated length was 8.5 +/- 2.0 mm in unresectable cases. There was no significant difference between type III and IV tumors, except for the rate of nodal metastasis (29.7 and 76.0%, respectively, p < 0.001).Hemihepatectomy might be selected for curative-intent resection of BC type IV tumors considering the advantageous biliary variations, whereas anatomical trisegmentectomy is recommended for the resectable bile duct length less than 10 mm. Biliary variations might result in excessive classification of BC type IV but require validation on further study.