Experomental and clinical studies to increase curability and safety of surgery for hilar cholangiocarcinoma

临床研究（1）通过胆道引流管胆道造影、经皮肝穿刺胆道镜、选择性血管造影、经皮肝穿刺门静脉造影及肝静脉造影可对癌灶范围作出准确的术前诊断。这反过来又导致了合理的外科手术。(2)胆管癌的神经浸润对患者的生存率有很大的影响，这表明彻底的胆管化切除是治疗的关键。(3)我们发展了一种新的经皮经肝门静脉栓塞术的方法，即同侧入路，这使得栓塞右或左三段门静脉成为可能。门静脉栓塞有可能增加肝门部胆管癌肝切除的安全性和扩大肝门部胆管癌肝切除的适应证。(4)在X线透视下，采用直接前入路，建立了肝门部胆管癌的多选择性胆道手术技术 关于我们 .这种积极的引流对于预防和/或治疗肝汇合处恶性胆道梗阻患者的节段性胆管炎至关重要。实验研究 * 以下结果是用大鼠或小鼠实验证明的。(1)与内引流不同，胆汁外引流不能抑制部分肝切除术后胆汁淤积性肝的再循环。(2)胆道感染，特别是与梗阻性黄疸相关的胆道感染，明显损害肝线粒体功能。胆汁引流对于改善受损功能绝对有效。(3)在选择性胆道梗阻的情况下，非胆汁淤积性肝叶和胆汁淤积性肝叶的肝线粒体功能也降低。这意味着整个胆道系统的胆汁引流是有益的。(4)脂肪乳剂在全肠外营养中的应用有助于肝部分切除术后的肝再生。(5)从DNA聚合酶和线粒体基因表达变化的角度来看，门静脉分支结扎以类似于部分肝切除术的方式诱导未结扎肝叶中的肝细胞增殖。(6)门静脉分支结扎可诱导非结扎肝叶的肝细胞增殖，与阻塞性黄疸无关。(7)肝脏中IL-10产生的增加涉及双丁酰cAMP对炎性肝损伤的保护作用。少

*Clinical Research*(1) Preoperative accurate diagnosis of cancer extent was achievable using cholangiography throgh biliary drainage catheter, percutaneous transhepatic cholangioscopy, selective angiography, pcrcutaneous transhepatic portography and hepatic venography. This, in turn led to rational surgical prcoedures. (2) Perineural lnvasion proved to have a profound impact on survival of the patients with bile duct carcinoma, indicating that thorough skeletonization resection is essential for curative intent. (3) We developed a new approach of percutaneous transhepatic portal vein cmbolization, the ipsilateral approach, which made it possible to embolize the right or left trisegment portal vein. Portal vein cmbolization had the potential to increase safety of and to extend indication of major hepatectomy for hilar cholangiocarcinoma. (4) Technique of multiple selective biliary for hilar cholangiocarcinoma was well established by the direct anterior approach under fluoroscopic control … More . This aggressive drainage was essential for preventing and/or treating segmental cholangitis in patients with malignant biliary obstruction at the hepatic confluence.*Experimental Research*The following resukts were demonstrated experimentally using rats or mioe. (1) External bilisry drainage, unlike internal drainage, does not suppress regcenration of cholestatic liver after partial hepatectomy. (2) Biliary infection, especially associated with obstructive jaundice, injures hepatic mitochondrial function markedly. Biliary drainage is definitely effective in improving the impaierd function. (3) Under a condition of selective biliary obstruction, hepatic mitochondrial function is decreased also in the non-cholestatic lobe, as well as the cholestatic lobc. This implies that biliary drainage of the entire biliary system is beneficial. (4) An application of lipid emulsion to total parenteral nutrition is useful for hepatic regeneration after partial hepatectomy. (5) Portal branch ligation induces hepatocyte proliferation in the non-ligated lobe in a way similar to partial hepatectomy, from the viewpoint of changes in DNA polymerases and mitochondrial gene expression. (6) Portal branch ligation induces hepatocyte proliferation in the non-ligated lobe, irrespective of obstructive jaundice. (7) An increment in IL-10 production in the liver is involved in the protective effect of dibutyryl cAMP on inflammatory liver injury. Less