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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (02) : 142 -146. doi: 10.3877/cma.j.issn.2095-3232.2023.02.004

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胆囊癌肝切除范围再认识
杨新伟1, 杨平华1, 闫兴州1, 邢相磊1, 刘虎1, 赵永洋1, 张克诚1, 张宝华1,()   
  1. 1. 200438 上海,海军军医大学附属东方肝胆外科医院胆道四科
  • 收稿日期:2022-12-27 出版日期:2023-03-28
  • 通信作者: 张宝华
  • 基金资助:
    国家自然科学基金青年项目(81902940); 海军院校和训练机构教学理论研究重点建设项目(海参训2019-9号)

Recognition of scope of hepatectomy for gallbladder cancer

Xinwei Yang1, Pinghua Yang1, Xingzhou Yan1   

  • Received:2022-12-27 Published:2023-03-28
引用本文:

杨新伟, 杨平华, 闫兴州, 邢相磊, 刘虎, 赵永洋, 张克诚, 张宝华. 胆囊癌肝切除范围再认识[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 142-146.

Xinwei Yang, Pinghua Yang, Xingzhou Yan. Recognition of scope of hepatectomy for gallbladder cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 142-146.

胆囊癌是胆道系统中最常见的恶性肿瘤,其发病率位于消化系统恶性肿瘤的第6位,且近年来发病率不断上升[1]。大多数胆囊癌就诊时已是疾病进展期,根治性手术切除是目前唯一有望治愈的方法[2]。2017年美国癌症联合委员会(AJCC)发布的第8版TNM分期中,原发肿瘤T分期是手术方式和肝切除范围最重要的影响因素[3]。2019年日本第3版胆道肿瘤临床实践指南推荐≥T1b期的胆囊癌行肝切除,但并未明确肝切除范围[4]。关于胆囊癌的肝切除范围仍存在诸多争议,我们根据最新的AJCC指南结合我们自己的临床数据和经验进行分享。

图1 一例术前无法判断T1和T2期的胆囊癌患者行肝S4b + S5段切除术注:术中显露肝动脉右前支(RFHA)、右后支(RPHA)和门静脉右前支(RFPV)、右后支(RPPV),PV为门静脉,LPV、RPV分别为门静脉左支和右支,CBD为胆总管
图2 一例进展期胆囊癌转化成功后行右三叶切除术注:术前行门静脉栓塞联合免疫治疗,3周获得足够的剩余肝体积
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