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The aim of this paper is to evaluate the efficacy of the surgical treatment for advanced hilar cholangiocarcinoma(CCA)in order to improve the resection rate and curative effect.A retrospective analysis was performed on the data of 24 patients who had undergone surgical treatment for advanced hilar CCA.According to the Bismuth classification,there were four cases of type IIIa,six cases of type IIIb,and 14 cases of type Ⅳ.Based on the treatment approaches,these resection group:There were five cases(one type Ⅲa,three type Ⅲb,and one type Ⅳ).The tumor visible to the naked eyes was resected thoroughly and the cut margin was free of tumor by microscopic examination.Then,Roux-en-Y hepatico-jejunal anastomosis was pergroup:There were 11 cases.The bile flow was restored by Roux-en-Y hepatico-jejunal anastomosis directly in five cases(two type Ⅲa,three type Ⅲb)and by inteal drainage through a hepatico-jejunal bridge in the other biliary drainage group:There were eight cases of type Ⅳ,including three cases with the inteal drainage through hepatico-jejunal bridge by laparotomy,three cases with endoscopic retrograde biliary drainage(ERBD),two cases with percutaneous transhepatic biliary drainage(PTBD).The rate of radical resection was 20.8% and the overall resection rate was 66.7%.All of the 24 patients were followed-up.The cumulative surviving rates were significantly different among these three groups(Log-rank X2=17.56,P=0.0002).For advanced hilar CCA,the best choice of treatment is radical resection.If radical resection is impractical,palliative resection combined with partial hepatectomy can significantly prolong the survival time.Inteal drainage through a hepatico-jejunal bridge can enhance the surgical resection rate and decrease the occurrence rate of postoperative biliary leakage.