目的探讨Ⅳ型肝门部胆管癌的初步治疗经验。方法收集2008年4月至2011年4月期间四川大学华西医院肝胆胰外科1个医疗组收治的20例Ⅳ型肝门部胆管癌患者的临床资料,对其术中及术后结果进行分析。结果 20例中行手术切除15例,切除率为75%。其中行根治性切除术10例,非根治性切除术5例;行左三肝+尾叶切除(右前右后肝管成形、肝管-空肠吻合+空肠-空肠Roux-en-Y吻合术)7例,行扩大右半肝切除+尾叶切除(左外左内肝管成形、肝管-空肠吻合+空肠-空肠Roux-en-Y吻合术)6例,行肝方叶切除(左外内、右前后肝管分别整形后行2个胆-肠吻合术)2例;其中2例因总胆红素>400 mmol/L而先行经皮肝穿刺胆管引流(PTCD)和门静脉栓塞(PVE)后再手术,1例行根治性切除术,另1例行非根治性切除术。不能切除者5例,其中3例因发生肝脏及远处广泛转移,行术中PTCD,另2例因肿瘤侵犯门静脉左右支,行术中T管引流、联合术后PTCD。行手术切除者术后1年生存率为100%,术后生存时间1～3年,平均1.5年;肿瘤未切除者生存3～6个月,平均4.2个月。本组无一例围手术期死亡。结论对于Ⅳ型肝门部胆管癌,术前应精确评估,力争切除肿瘤,解除胆管梗阻;如不能一期切除则行PTCD和PVE,力争二期切除。 Objective To investigate the preliminary treatment experience of type Ⅳ hilar cholangiocarcinoma. Methods The clinical data of 20 patients with type Ⅳ hilar cholangiocarcinoma admitted to a medical group of hepatobiliary and pancreatic surgery in West China Hospital of Sichuan University from April 2008 to April 2011 were collected and their intraoperative and postoperative outcomes were analyzed. Results 20 cases of surgical resection in 15 cases, resection rate of 75%. Among them, 10 cases were treated by radical resection and 5 cases were treated by non-radical resection. Roux-en-Y anastomosis was performed on the right and left posterior hepatic duct, right hepatic duct, jejunum and jejunum, Six patients undergoing resection of the right hepatic resection + caudate lobectomy (left external left internal hepatic duct formation, hepatic duct-jejunum anastomosis + jejunum Roux-en-Y anastomosis) 2 cases of internal and right anterior and posterior hepatic duct were reconstructed, respectively. Two cases were treated with percutaneous transhepatic biliary drainage (PTCD) and portal vein embolism (PVE) with total bilirubin> 400 mmol / L ) And then surgery, 1 case of radical resection, and the other a non-radical resection. 5 cases were unresectable, of which 3 cases were extensively metastasized due to the occurrence of liver and distant metastasis. The intraoperative PTCD was performed and the other 2 cases were inflated by the tumor to the left and right branches of the portal vein. The T-tube drainage was performed during the operation, and postoperative PTCD was combined. Surgical resection of 1-year survival rate was 100%, postoperative survival time of 1 to 3 years, an average of 1.5 years; survived 3 to 6 months of tumor resection, an average of 4.2 months. No case of perioperative death in this group. Conclusions For type Ⅳ hilar cholangiocarcinoma, preoperative evaluation should be performed accurately to remove the tumor and relieve the obstruction of the bile duct. If one-stage resection is not possible, perform PTCD and PVE in the second stage of resection.