中文摘要：

手术切除是目前治疗肝门部胆管癌最有效的手段，切除范围不足是术后肿瘤复发的主要因素之一。近年来国内外趋于实施扩大的根治性切除，能够提高远期生存率，但大范围肝叶切除的主要风险是术后发生肝功能衰竭。本文报道一种既保证足够的肝内外胆管切除范围、又最大限度地减少肝组织切除的肝门部胆管癌根治性切除术式。该术式的切除范围包括肝IVb段、右肝蒂前部分肝V段的肝组织，左右肝管、分叉部、肝外胆管及尾状叶（肝I段），同时行肝门区血管骨髂化及至少包括第2站淋巴结的清扫。因所切除组织整体上形似哑铃状，我们称之为“哑铃”式肝门部胆管癌根治术。手术指征：（1）Bismuth Ⅱ型肝门部胆管癌，以及部分肿瘤局限于一级肝管内的Ⅲa、Ⅲb型肝门部胆管癌；（2）无门静脉分叉部或左右支受侵；（3）第3站淋巴结无转移；（4）无肝内或远处组织器官转移。本研究23例患者完成该术式，术前多数患者TBil〉300μmol／L，均未行PTCD或胆管内支架引流。平均手术时间为355min。术中平均出血量为350ml。患者1、3年无瘤生存率分别为95．7％（22／23）和7／15。其结果表明：该术式适宜于我国目前条件下Bismuth Ⅱ型肝门部胆管癌及部分肿瘤局限于一级肝管内的Ⅲa型或Ⅲb型的患者。

英文摘要：

Surgical resection is considered to be the most effective therapy for hilar cholangiocareinoma. Inadequate excision range is the main reason for recurrence after surgery. Extended radical resection provides better long-term survival, however, it may also increase the risk of liver failure because of the extensive hepatic resection. In present study, we showed a new operation which could excise enough length of bile ducts and avoid large volume hepatic tissue resection. The excision extension includes： segment I, Ivb and partial IV, left, right and furcationof hepatic duct, extrahepatic ducts, skeletonization of hilar vessels, and dissection of at least second station lymph nodes. As the tissue resected resembles a dumbbell, this surgical tech- nique is named dumbbell type radical resection. The operative indications include： （1） hilar cholangiocarcinoma, Bithmuth Ⅱ and Bithmuth Ⅲ with tumor limited in left or right hepatic ducts ; （2） Without portal invasion; （ 3 ） Without third station lymph node metastasis; （4） Without liver or distant organ metastasis. Twenty-three patients had undergone this operation sucessfully. Most patients have high total bilirubin levels （more than 300 μ mol/L） and have not received percutaneous transhe- patic cholangial drainage or biliary drainage. The average opera- tion time was 355 minutes, and average volume of blood loss during operation was 350 ml. The total survival rate was 65.2%. One-year tumour free survival rate was 95.7% （ 22/23 ） , and three-year tumor free survival rate was 7/15. The results indica- ted that dumbbell type radical resection was feasible for hilar cholangiocarcinoam of Bismuth Ⅱ and Bismuth Ⅲ with tumor limited in left or right hepatic ducts.