Value and evaluation of hilar surgical approach in hilar biliary stricture / 中国实用外科杂志

Hilar biliary stricture is usually divided into malignant stricture and benign stricture. How to effectively deal with hilar biliary stricture has always been the focus in biliary surgery. Because it involves bile duct, hepatic artery,portal vein and liver parenchyma, the choice of surgical path is very important. The approach based on perihilar surgical technique can better expose the operative area and have the advantage of performing precise treatment, thus effectively improving the radical cure rate of hilar cholangiocarcinoma and reducing the surgical difficulty.

Application of perihilar surgical technique in the treatment of central cholangiectasis / 中国实用外科杂志

Central biliary dilatation (BD) is a primary biliary disease characterized by intrahepatic central biliary dilatation with or without extrahepatic biliary dilatation, including B1, B2, D1 and D2 in Dong clinical classification. Because of its great anatomical variability, impaired liver function, difficulty in preoperative evaluation and complicated operation, central BD has a high incidence of complications and poor prognosis.In view of the difficulties in diagnosis and treatment of central BD, comprehensive application of perihilar surgical technique,through preoperative systemic perihepatic portal imaging evaluation and liver function maintenance, individualized surgical treatment and comprehensive postoperative management will help to improve the surgical efficacy of central BD.

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

Intrahepatic cholangiocarcinoma invading hepatic hilum has the biological characteristics and clinical features of both gallbladder cancer and hilar cholangiocarcinoma, and it also combines the pathophysiological changes of liver disease.There are a series of therapeutic difficulties such as difficult exposure of three hepatic hilum, complexity of liver resection,difficult treatment of combined liver diseases and insensitivity to radiotherapy and chemotherapy, which result in low radical resection rate, difficulty in operation, high operative risk and poor prognosis. The perihilar surgical technique system based on special clinical features, surgical methods and pathophysiological characteristics, evaluates the tumor resectability, the anatomy structure of three hepatic hilum and the reserved liver function comprehensively and accurately before surgery, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, combined with accurate liver resection, accurate and high-quality biliary anastomosis and management of postoperative complication,which can improve surgical radicalization and safety, reduce surgical risk and postoperative complication rate, thereby improve the overall survival time of patients.

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.

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.