Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment.
Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment.
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DOI：
10.1007/s00534-007-1279-5
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Miura, Fumihiko
中科院分区：
文献类型：
--
作者：
Kondo, Satoshi;Takada, Tadahiro;Miyazaki, Masaru;Miyakawa, Shuichi;Tsukada, Kazuhiro;Nagino, Masato;Furuse, Junji;Saito, Hiroya;Tsuyuguchi, Toshio;Yamamoto, Masakazu;Kayahara, Masato;Kimura, Fumio;Yoshitomi, Hideyuki;Nozawa, Satoshi;Yoshida, Masahiro;Wada, Keita;Hirano, Satoshi;Amano, Hodaka;Miura, Fumihiko
关键词：
胆道癌的唯一治愈性治疗是手术治疗。因此，应首先研究根治性切除术的适用性。在肝、肺、腹膜或远处淋巴结转移的情况下，根治性切除是不合适的。关于局部扩展因子和可治愈性尚未达成明确的共识。黄疸肝脏的肝脏储备功能的测量包括未来肝脏残余体积和吲哚菁绿色（ICG）清除试验。对于计划进行右半肝切除或更多肝切除术或切除率超过50%-60%的肝切除术的患者，可考虑术前门静脉栓塞。术后并发症和手术相关的死亡率可能会减少门静脉栓塞的使用。虽然肝切除术和/或胰管切除术是胆管癌根治性切除术的首选，但在严格诊断其局部扩展后判断可实现根治性切除的患者中，也可考虑单独行肝外胆管切除术。肝门部胆管癌推荐采用联合尾状叶切除术。由于门静脉联合切除术患者的预后明显好于未切除患者，因此可以进行门静脉联合切除术。胆管癌切除术后的预后因素包括手术切缘阳性，特别是在导管残端;淋巴结转移;神经周围浸润;以及由于门静脉和/或肝动脉浸润而联合血管切除。对于怀疑胆囊癌的患者，不建议腹腔镜胆囊切除术，应常规行开腹胆囊切除术。单纯胆囊切除术后发现胆囊癌侵犯浆膜下或更深者，应考虑再次切除。胆囊癌切除术后的预后因素包括壁浸润深度、淋巴结转移、壁外侵犯，特别是肝十二指肠韧带、神经周围浸润和可治愈性程度。壶腹癌宜行胰十二指肠切除术，腺瘤内癌宜行局限性手术。壶腹癌切除术后的预后因素包括淋巴结转移、胰腺浸润和神经周围浸润。
The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%–60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.
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DOI：
10.1007/s00534-004-0895-6
发表时间：
2004-01-01
期刊：
JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY
影响因子：
--
作者：
Beger, HG;Thorab, FC;Rau, BM
通讯作者：
Rau, BM
DOI：
10.1007/s005340050165
发表时间：
2000-01-01
期刊：
Journal of hepato-biliary-pancreatic surgery
影响因子：
--
作者：
Gazzaniga, G M;Filauro, M;Mori, L
通讯作者：
Mori, L
影响因子：
1.6
作者：
Kaiho, T;Miyazaki, M;Nakajima, N
通讯作者：
Nakajima, N
影响因子：
9
作者：
Hemming, AW;Reed, AI;Howard, RJ
通讯作者：
Howard, RJ
影响因子：
9
作者：
Kawasaki, S;Imamura, H;Miyagawa, S
通讯作者：
Miyagawa, S