肝门周围胆管癌的中枢性肝切除术：一种保留实质肝切除术预防肝切除术后肝衰竭的替代技术。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-05-01 DOI:10.1016/j.hpb.2025.01.002

Masahiro Fujisawa, Ryuji Yoshioka, Atsushi Takahashi, Shoichi Irie, Yoshinori Takeda, Hirofumi Ichida, Hiroshi Imamura, Yoshihito Kotera, Yoshihiro Mise, Akio Saiura

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引用次数: 0

摘要

背景：肝门周围胆管癌（PHC）通常需要大肝切除术和肝外胆管切除术，肝切除术后存在肝衰竭（PHLF）的风险。中心肝切除术（CH）是一种替代技术，目的是保留功能性肝脏储备。本研究评估了保实质肝切除术对PHC患者的可行性和预后。方法：回顾性分析2019年3月至2023年1月期间接受CH治疗的PHC患者。术前评估包括多模态成像和评估未来的残肝体积。结果：14例患者因PHC行CH。肿瘤部位为肝门周围胆管（10例）和整个肝外胆管（4例）。中位手术时间679.5 min，术中出血量450 mL。2例患者发生临床相关PHLF， 1例败血症相关死亡。9例患者实现R0切除。结论：肝功能储备可保留PHC的肝功能储备，有降低phf风险的潜力。充分的术前评估是至关重要的，肿瘤预后需要进一步调查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Central hepatectomy for perihilar cholangiocarcinoma: an alternative technique for parenchymal-sparing hepatectomy to prevent post-hepatectomy liver failure

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Central hepatectomy for perihilar cholangiocarcinoma: an alternative technique for parenchymal-sparing hepatectomy to prevent post-hepatectomy liver failure

Background

Perihilar cholangiocarcinoma (PHC) often requires major hepatectomy with extrahepatic bile duct resection, carrying the risk of post-hepatectomy liver failure (PHLF). Central hepatectomy (CH), an alternative technique, aims to preserve functional liver reserve. This study evaluated the feasibility of CH and outcomes for patients with PHC within the paradigm of parenchymal-sparing hepatectomy.

Methods

A retrospective analysis included PHC patients who underwent CH between March 2019 and January 2023. Preoperative evaluations involved multimodality imaging and assessment of future remnant liver volume.

Results

Fourteen patients underwent CH for PHC. Tumor locations were perihilar bile duct (10 patients), and entire extrahepatic bile duct involvement (four patients). Median operative time and intraoperative blood loss were 679.5 min and 450 mL, respectively. Clinically-relevant PHLF occurred in two patients, with one sepsis-related death. Nine patients achieved R0 resection. Functional liver reserve parameters exceeded the standard procedure (p < 0.01).

Conclusion

CH for PHC preserves functional liver reserve, potentially reducing PHLF risk. Adequate preoperative evaluation is crucial, and oncological outcomes require further investigation.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).