Application of perihilar surgical techniques in biliary tract surgery / 中国实用外科杂志

Perihilar biliary diseases have a wide spectrum of diseases including stones, inflammation, tumors, injuries and congenital malformations. Because of their characteristics such as anatomic variability, pathophysiological complexity, high operative difficulties, more postoperative complications and high operative risk, the perihilar biliary surgery is a high difficulty area in biliary surgery. For common clinical features ,common surgical methods and common technical difficulties of perihilar biliary diseases, the perihilar surgical technique system adequately evaluates hilar anatomy and its variations,liver function and volume of residual liver relying on threedimensional digital medical imaging technology, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, then re-evaluates the relationship between the lesion and the hepatic artery and portal vein, and ultimately sets the surgical procedure . It is developed to improve the R0 resection rate, quality of cholangiojejunostomy, quality of vascular resection and reconstruction and safety of operation,eventually for the purpose of reducing postoperative complication rate and perioperative mortality and improving the prognosis. So surgeons should pay attention to the comprehensive system involving multiple disciplines in order to improve the effectiveness and safety in diagnosis and treatment of perihilar biliary diseases.

Application of perihilar surgical techniques in gallbladder cancer invading hepatic hilum / 中国实用外科杂志

Gallbladder cancer invading hepatic hilum has both the biological characteristics of gallbladder cancer and the clinical features of hilar cholangiocarcinoma. There are a series of therapeutic difficulties such as difficult exposure of hepatic hilum, multiple organ resection, resection and reconstruction of hilar vessels, complex cholangiojejunostomy and liver functional restriction, which result in low radical resection rate, difficulty in operation, high operative risk, more postoperative complications and perioperative mortality. The perihiliar surgical technique system adopts accurate preoperative three-dimensional imaging evaluation and liver function evaluation, and completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, which is beneficial to intraoperative re-evaluation. It can improve the R0 resection rate, quality of vascular resection and reconstruction, quality of cholangiojejunostomy, and reduce perioperative morbidity and mortality. Surgeons should pay attention to the combination of perihiliar surgical technique and oncology in order to screen which patients will benefit from operation.