以功能保留为核心的胆道肿瘤多阶段治疗体系:微创、动态功能评估与康复整合OA

Radical resection remains the cornerstone of long-term survival in biliary tract cancers(BTC).However,obstructive jaundice,cholangitis,impaired hepatic reserve,and treatment-related liver injury concentrate perioperative risks along a"cholestasis-infection-functional failure"cascade,and minimally invasive access alone cannot offset these functional costs.Based on current guidelines and emerging evidence,we propose a multistage care pathway centered on the concept of functional resectability,encompassing conversion/neoadjuvant therapy,preoperative functional reassessment,function-oriented surgery,and postoperative rehabilitation with long-term follow-up.Preoperative decision-making is anchored to combined"volume-plus-function"evaluation of the future liver remnant.When necessary,regional liver function is quantified using 99mTc-mebrofenin SPECT/CT and indocyanine green clearance testing,while selective biliary drainage,infection control,nutritional and coagulation optimization,and portal vein embolization are applied to establish a functional safety window.Intraoperatively,indocyanine green fluorescence imaging,intraoperative ultrasound,and three-dimensional planning are integrated to facilitate R0 resection and optimize reconstruction.Postoperatively,ERAS-based management is adopted,and key endpoints-including post-hepatectomy liver failure,clinically relevant postoperative pancreatic fistula,and patient-reported outcomes-are used to evaluate treatment benefit.This pathway emphasizes a"function-first,minimally invasive second"strategy,forming a closed loop of dynamic assessment,proactive intervention,and outcome measurement to maximize functional preservation and quality of life while maintaining oncological radicality.