探讨功能胆道外科理念在围肝门胆道恶性肿瘤应用的安全性及临床疗效。

回顾性分析2020年10月至2021年6月解放军总医院第一医学中心的4例围肝门胆道恶性肿瘤根治术后胆管对端吻合重建手术患者的临床资料。

4例手术中1例开腹手术、3例机器人手术完成；肝总管-胆总管对端吻合3例、左肝管-胆总管对端吻合1例；平均手术时间(217.5±65.5)min，平均术中出血量100 ml( 50~200 ml)，平均术后住院(9.3±3.6)d。其中1例腹水、1例胆瘘，无严重并发症。术后中位随访时间5.3个月(范围2~9个月)。4例患者肿瘤无复发表现，血液总胆红素、肿瘤标记物均正常。

功能胆道外科理念在围肝门胆道恶性肿瘤的应用是安全、可行的，在保障患者病灶彻底切除的同时，充分保留了消化道结构和生理功能的完整性。

To explore the safety and clinical effect of application of functional biliary-tract surgical concepts in radical operation for perihilar malignant tumor.

From Oct. 2020 to Jun. 2021, the clinical data of 4 patients undergoing choledochocholedochostomy reconstruction with radical operation for perihilar malignant tumor was collected.

Of 4 cases, 1 case was performed laparotomy and 3 cases were robotic surgery. There were 3 cases of common hepatic duct to common bile anastomosis, and 1 case of left hepatic duct to common bile anastomosis. The mean operation duration was (217.5±65.5) min, the median intraoperative bleeding was 100 ml(50-200 ml), and the mean postoperative hospital stay was (9.3±3.6)days. Among the 4 cases, 1 case was ascites and 1 case was biliary fistula. There were no serious complications. The median follow-up was 5.3 months (range 2 to 9 months). There was no recurrence of tumor in 4 patients, and blood total bilirubin and tumor markers were normal.

Application of functional biliary-tract surgical concepts in radical operation for perihilar malignant tumor is safe and feasible. The integrity of digestive tract structure and physiological function is fully preserved while the radical treatment of tumor is ensured.