从转化治疗到腹腔镜根治性切除:一例Bismuth-Corlette Ⅳ型肝门部胆管癌的诊疗OA

Hilar cholangiocarcinoma(HCCA)is the most common malignant tumor in the biliary system,which is characterized by insidious onset,rapid progression,high invasiveness,and poor prognosis.Currently,radical surgical resection remains the only effective means for HCCA patients to achieve long-term survival.Conversion therapy,which downsizes initially unresectable tumors to enable radical resection,has become an important strategy for improving the prognosis of advanced HCCA patients.This article reported a case of a patient with initially unresectable Bismuth-Corlette type Ⅳ HCCA who presented with severe jaundice.Imaging revealed invasion of the proper hepatic artery and locally advanced disease,rendering the patient ineligible for immediate radical surgery.After 5 cycles of conversion therapy with a PD-1 inhibitor combined with the GemOx regimen(gemcitabine+oxaliplatin),follow-up examinations showed significant tumor regression.Additionally,contrast-enhanced CT identified a replaced right hepatic artery originating from the gastroduodenal artery,providing compensatory blood supply to the right liver and making radical resection feasible.Ultimately,the patient successfully underwent total laparoscopic HCCA radical resection and recovered well postoperatively.This article reviewed the diagnostic and therapeutic process,the clinical value of conversion therapy and timing of surgery,as well as the application of minimally invasive techniques in advanced HCCA,aiming to provide new insights for the clinical management of these patients.