Mesohepatectomy, caudate lobectomy and resection of hilar bifurcation with biliary reconstruction by 6 hepaticojejunostomies for Klatskin tumor.
Mesohepatectomy, caudate lobectomy and resection of hilar bifurcation with biliary reconstruction by 6 hepaticojejunostomies for Klatskin tumor.
复制标题
肝系切除术、尾状叶切除术和肝门分叉切除术并通过 6 次肝空肠吻合术重建 Klatskin 肿瘤。
作者：
H. Lang;G. Sotiropoulos;M. Malágo;C. Broelsch
本文介绍了对IV型Klatkin肿瘤行肝系膜切除，包括尾状叶切除、肝门分叉切除和胆管重建6例。这种技术要求严格的手术入路不仅需要仔细的血管剥离以维持剩余肝脏部分的血供和静脉引流，而且还承担了双侧胆管重建和两个切面的风险。与扩大的肝切除术相比，肝系膜切除术的主要优点是保留了正常的肝组织。因此，尽管有技术上的挑战，肝系膜切除术在选择的晚期肝门部胆管癌病例中可能是一个有吸引力的选择，在这些病例中，由于残留的肝组织很少，不建议扩大肝脏切除术。在这些病例中，肝系膜切除降低了术后肝功能不全的风险，但仍允许肿瘤切除。
We describe the technique of mesohepatectomy including caudate lobectomy and resection of hilar bifurcation with biliary reconstruction by 6 hepaticoejunostomies for a Klatskin tumor type IV. This technically demanding approach does not only require careful vascular dissection to maintain blood supply and venous drainage of the two remaining liver parts but it also bears the risks of bilateral biliary reconstruction and of two resection surfaces. The major advantage of mesohepatectomy in comparison to extended hepatectomy is the preservation of functioning liver tissue. Therefore, despite its technical challenges, mesohepatectomy may be an attractive alternative in selected cases of advanced hilar cholangiocarcinoma in which an extended liver resection is contraindicated due to the small amount of remaining liver tissue. In these cases mesohepatectomy reduces the risk for postoperative liver insufficiency but still allows oncologic tumor resection.