原位肝移植联合胰头十二指肠切除根治肝门部胆管癌  

Combined total hepatectomy,orthotopic liver transplantation and pancreatoduodenectomy for irresectable hilar bile duct carcinoma

作　　者：何晓顺[1] 张劭[1] 朱晓峰[1] 计勇[1] 曾纪晓[1] 马毅[1] 王东平[1] 鞠卫强[1] 巫林伟[1] 李志[2] 黄洁夫[3] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080 [2]中山大学附属第一医院病理科,广州510080 [3]中国协和医科大学

出　　处：《中华外科杂志》2006年第5期302-305,共4页Chinese Journal of Surgery

基　　金：广东省教育厅"千百十人才工程"基金资助项目(Q02033);广东省科委攻关基金资助项目(99M04902G)

摘　　要：目的探讨原位肝脏移植联合胰头十二指肠切除根治复杂肝外胆管癌的方法及疗效。方法结合国外临床经验和肝外胆管癌的生物学特点,对1例B ismuth-CorletteⅣ型肝外胆管癌侵犯肝内二级胆管及胆总管下段的患者,实施原位肝脏移植联合胰头十二指肠根治性切除。采用链霉素-卵白素-生物素(LSAB)的免疫组织化学技术,检测切除的病理标本中胆管上皮细胞角蛋白CK9和CK17、癌胚抗原、肝细胞蛋白,确认肿瘤组织学来源。术后给予他克莫司联合甲泼尼龙片抗排斥治疗。同时,拉米夫定联合大剂量乙型肝炎免疫球蛋白静脉滴注预防乙型肝炎复发,术后定期随访。结果术后移植肝的肝功能恢复顺利,血清胃肠道肿瘤标志癌胚抗原、CA19-9、CA125均降至正常范围。随访14个月至今,移植肝及消化功能良好,患者健康并恢复术前工作。结论对无远处转移和腹腔播散,且常规手术无法根治的浸润型肝门部胆管癌B ismuth-CorletteⅣ型,可考虑实施全肝、肝十二指肠韧带联合胰头十二指肠整块切除术根治肿瘤。然后行同种异体原位肝移植并重建消化道。该方法可能有利于提高肿瘤的切除率和患者长期生存率。Objective To explore the feasibility and outcome of combined hepatectomy, orthotopic liver transplantation and Whipple＇s pancreatoduodenectomy for radical excision of cholangiocarcinoma. Methods A 35-year-old female patient with irresectable cholangiocarcinoma underwent curative radical operation, which includes hepatectomy, orthotopic liver transplantation and pancreaticeduedenectomy of hilar bile duct carcinoma; immunosuppression followed an induction protocol with FK506 and steroids. Lamivudine and HBIg were used to prevent hepatitis B virus from infection again. Results Pathologic examination revealed low differentiated cholangiocarcinoma and immunohistochemistry stains demonstrated positive expression of cytokeratin 9 and 17, carcinoembryonic antigen and the hepatocyte protein was negative. Neither the margins of resection nor the periductal lymph nodes were involved. The liver showed evidence of cholestasis and metastasis nod. The patient was hospitalized 32 days and came back to the previous work. He has been followed up for more than 14 months up to now and is currently alive without any evidence of recurrent cancer. Condusions For some selected unresectable Klatskin＇s tumors, combined hepatectomy, pancreateduodenectomy and orthotopic liver transplantation was justified. The radical methods maybe provide long-time survival and curative effect. Nevertheless, because of possible tumor recurrence and ethical controversy, the combined hepatectomy, pancreateduodenectomy and orthotopic liver transplantation procedure has to be applied only with caution and indications.

关 键 词：肝移植 胰头十二指肠切除术 胆管癌 肝门部 

分 类 号：R735.8[医药卫生—肿瘤]