胆道恶性肿瘤外科治疗的问题和对策

Problems and strategy in surgical treatment of biliary tract tumors

  • 摘要: 胆道恶性肿瘤早期即可发生转移,预后较差,且发病率近年来有上升趋势。相对于其他消化道肿瘤,胆道系统的肿瘤研究起步较晚,且胆道系统的跨越范围较广,上至肝脏,下行穿过胰腺进入十二指肠,涉及3个脏器,同时和门静脉、肝动脉等重要脏器紧邻,无论外科治疗还是辅助治疗都存在很多问题需要解决。外科治疗尚未解决的几大问题包括:术前如何准确评估、术前是否需要减轻黄疸、肝切除范围、淋巴结清扫范围、动静脉受累是否需要切除重建、肝移植是否适应于肝内胆管癌和肝门部胆管癌、早期胆囊癌的手术范围等。

     

    Abstract: Biliary tract tumor is a high degree mali-gnancy, which presents with early metastasis and poor prognosis. However, the incidence keeps increasing in recent years compared with other digestive system tumors, the clinical and basic research started late. The biliary tract system is very complicated, it starts up to the liver, descending through the pancreas into the duodenum, involving these three organs, beside this, the portal vein and the hepatic artery are in close proximity. Thus, there are many problems to be solved in current surgical treatment, including how to assess accurately before surgery, whether to undergo preoperative biliary drainage, the extent of liver resection, the extent of lymph node dissection, whether venous involvement should be resected and constructed, whether liver transplantation is useful to these tumors, operation scope of early gallbladder carcinoma.

     

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