高位切除治疗肝门胆管癌疗效分析  

The therapeutic effect analysis of high-level resection of hepatic ducts in hilar cholangiocarcinoma

作　　者：郑光琪[1] 

机构地区：[1]四川大学华西青羊校区成都满地可医院,四川成都610091

出　　处：《中国实用外科杂志》2006年第3期184-185,共2页Chinese Journal of Practical Surgery

摘　　要：目的探讨高位切除治疗晚期肝门胆管癌的疗效。方法1995～2004年收治的13例晚期肝门胆管癌均施行高位肝管切除。根据肝门胆管癌向肝内外侵犯方向和范围,分为2组。A组8例,肝门胆管癌向肝内外侵犯,其中7例侵犯肝内2、3级肝管;B组5例,2例左肝内大胆管癌侵犯右肝管,3例侵犯右侧2级肝管。A组采用肝门胆管癌骨骼化切除,中央肝切除7例、左肝叶切除1例,3～9支肝管断端重建新的肝门胆管后与空肠行Y形吻合。B组采用切除肝左叶和肝门胆管,右肝管整形后与空肠Y形吻合。结果1例术后死于肝功能衰竭,高位切除肝管的10例中存活10年1例,4年2例,2年2例。结论骨骼化切除、中央肝切除、高位肝管切除和胆肠引流重建能改善晚期肝门胆管癌的疗效。Objective To evaluate the therapeutic effect of high level resection of hepatic duct in treatment of advanced hilar cholangiocarcinoma （HC）. Methods A total of 13 cases of advanced HC in the Montreal Hospital of Chengdu from 1995 to 2004 were divided into two groups. Group A：8 cases of HC with intrahepatic and extrahepatic duct invasion. Of them ,7 cases invaded to second or three grade intrahepatic duct. Group B ：5 cases of large left intrahepatic cholangiocarcinoma with right hepatic duct （RHD,2 cases） or second grade of RHD （3 cases） invasion. Skeletonization resection,central hepatectomy, and reconstruction of a new hilar bile duct （HBD） from 3 - 9 branches of intrahepatie bile duct by Roux-en-Y cholanglojejumostomy were performed for the patients in group A. Left hepatic lobectomy; resection of HBD, reconstruction of RHD,and Y type cholangiojejunostomy were performed for the patients in group B. Results One patient died postoperatively from hepatic failure. One case Survived for ten years,2 for four years, and 2 for two years with a ratio of 41.7% in those survival longer than two years. Conclusion Skeletonization resection, central hepatectomy, and HBD resection at a high level could improve the therapeutic effect of advanced HC.

关 键 词：肝门胆管癌 骨骼化切除 肝管高位切除 肝门胆管重建 

分 类 号：R6[医药卫生—外科学]