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四、胆道肿瘤相关术语

(一)胆道肿瘤及癌前病变的中英文名称

本书中涉及的胆囊肿瘤及其癌前病变的中英文名称见表1-0-2。

表1-0-2 胆道肿瘤及其癌前病变中英文名称

(二)肝切除术的规范化称谓

依据肝脏Couinaud解剖分段法 [72,73] 及中华医学会外科学分会肝脏外科学组制订的肝切除手术命名法(2017年第1次修订,第2版) [74] ,在本书中对胆道肿瘤外科治疗涉及的肝切除术进行下述规范性命名:

1.非解剖性肝切除

(1)肝肿瘤剜除术(enucleation of hepatic tumor):

在肝实质中沿肿瘤包膜外分离,直至将肿瘤完整地剜除,最大限度保留肝实质,常用于肝血管瘤等肝内良性肿瘤。

肝内胆管癌、胆囊癌肝侵犯或肝内转移等胆道肿瘤外科治疗术式,不应采用肝内肿瘤剜除的术式。

(2)限制性肝切除术(limited hepatectomy):

通常是指为保留更多的肝实质,肝实质离断切缘距离肿瘤边界小于1cm。

胆道肿瘤外科治疗术式不建议常规应用限制性肝切除术。

(3)局部性肝切除术(local hepatectomy):

是在距肿瘤边缘≥1cm的正常肝组织处离断肝实质,以达到既能将肿瘤完全切除,又可以更多保留残肝组织的目的。

部分肝内胆管癌、胆囊癌肝侵犯或肝转移等适用于局部性肝切除术。

(4)其他特殊类型的非解剖性肝切除术

1)肝楔形切除术(wedge hepatectomy):

肝楔形切除术是肝部分切除术的一种类型,主要适用于肝边缘部肿瘤的切除。

对于T3期、无肝内广泛转移的胆囊癌,可行距胆囊床3cm的肝楔形切除术。

2)围肝门切除术:

围肝门区域是指第一肝门附近、包含血管及胆管的狭小空间解剖区域,随着肝脏外科临床实践及解剖的发展,在肝胆外科学界逐渐形成了这一约定俗成的称谓,其范围界定于肝脏脏面H形横沟区域内 [75] 。董家鸿等认为围肝门区域涵盖经过第一肝门的脉管及其周围组织结构,包括肝十二指肠韧带、尾状叶、肝脏4b段和5段、肝门板等 [76] 。围肝门切除术即指在围肝门区域内实施的肝切除术,也有人称之为中央型肝切除(central hepatectomy) [77] ,其本质是一种保留功能肝实质的肝切除术(parenchyma-preserving hepatectomy),主要应用于部分肝门部胆管癌及胆囊癌的手术方案中 [78,79]

2.解剖性肝切除

(1)肝段切除术(hepatic segmentectomy):

将某一肝段全切除,称肝段切除术。

(2)半肝切除术(hemi-hepatectomy):

正常以肝正中裂为界将肝脏分为左、右两半,沿着正中裂切开肝包膜、离断肝实质,将左半肝或右半肝予以完全切除,称为半肝切除术。右半肝的完全切除(Ⅴ、Ⅵ、Ⅶ、Ⅷ肝段),称为右半肝切除术。左半肝的完全切除(Ⅱ、Ⅲ、Ⅳ肝段),称为左半肝切除术,Ⅰ肝段切除可独立命名为肝尾状叶切除术。

(3)肝三叶切除术(hepatic trilobectomy):

同时切除肝右后叶、右前叶及左内叶(Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ段),称肝右三叶切除术;同时切除肝左外叶、左内叶及右前叶(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅷ肝段),称肝左三叶切除术。

3.根据肝切除范围命名

(1)肝部分切除术(partial resection):

指仅切部分肝脏,包括解剖性和非解剖性肝切除,可分为小范围肝切除和大范围肝切除两种。

(2)小范围肝切除(minor hepatectomy):

<3个肝段的肝切除。

(3)大范围肝切除(major hepatectomy):

≥3个肝段的肝切除。国内也有“大部肝切除”的称谓,在本书中统一为表述“大范围肝切除”。

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