肝门部胆管癌根治术肝动脉重建17例分析  

Hepatic artery reconstruction after radical resection of hilar cholangiocarcinoma： a report of 17 cases

作　　者：汪谢丹[1] 郑启昌[1] 胡青刚[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《中华普通外科杂志》2007年第6期401-403,共3页Chinese Journal of General Surgery

摘　　要：目的 总结肝门部胆管癌根治术后肝动脉重建的经验。方法 回顾性分析1999年9月至2006年9月17例肝门部胆管癌根治术中行肝动脉切除后重建资料及随访结果。结果 17例患者行联合肝动脉切除的肝门部胆管癌根治术，根据Bismuth-Corlett分型，Ⅱ型行骨骼化切除1例，Ⅲa型行右半肝或加右尾叶切除7例，Ⅲb型行左半肝或加左尾叶切除8例，Ⅳ型左半肝加全尾叶切除1例。16例患者行肝动脉端端吻合，1例用胃十二指肠动脉与肝动脉吻合，1例门静脉部分切除自身大隐静脉补片修复。7例行肝内胆管支撑加肝门胆管空肠吻合。17例术后出现全身炎症反应综合征，2～3d明显缓解，1例上消化道出血治愈。术后彩色超声监测，显示重建肝动脉通畅。无术后30d内死亡，随访15例，中位生存期为22个月（6～60个月）。结论 联合肝动脉切除可以提高肝门部胆管癌根治率，肝动脉切除后重建能减少术后并发症的发生。Objective To sum up the clinical experience of hepatic artery reconstruction during radical resection of hilar cholangiocarcinoma. Methods Between Sep 1999 and Sep 2006, seventeen cases of hilar cholangiocarcinoma with hepatic artery invasion were subjected to radical resection with immediate hepatic artery reconstruction. Results Seventeen cases underwent radical resection. According to the Bismuth-Corlett classification, tumors were classified into four types, skeletonization resection was performed in type Ⅱ （ 1 case）. Right lobectomy with right caudate lobectomy was performed in type Ⅲa （7 cases）, Left lobectomy with left caudate lobectomy in type Ⅲ b （8 cases）. Left lobectomy with whole caudate resection （1 case） was undertaken in type Ⅳ. Hepatic artery was reconstructed using end to end anastomosis in 16 cases. Hepatic artery reconstruction was performed using the gastroduodenal artery in one case. Combined portal vein resection was performed in 1 patient and with immediate repair using great saphena. Seven patients had Roux-en-Y hepaticojejunostomy reconstruction and intrahepatic bile ducts stent. All patients suffered from postoperative SIRS and recovered within 2 - 3 days. Massive bleeding from the upper alimentary tract occurred and was controlled in one case. Postoperative blood flow of reconstructed hepatic arteries as monitored by Doppler was normal. There was no inhospital mortality in this series. Follow up in 15 patients revealed a median survival time of 22 months （ 6 months to 60 months ）. Conclusion Combination with hepatic artery resection can increase the radical resection rate and hepatic artery reconstruction can decrease the postoperative complications.

关 键 词：胆管肿瘤 外科手术 肝动脉重建 

分 类 号：R686[医药卫生—骨科学]