选择性胆管外引流在肝门部胆管癌根治性切除术中的应用  

Application of selective external biliary drainage in radical resection of hilar cholangiocarcinoma

作　　者：曾永毅[1] 刘景丰[1] 石铮[1] 池闽辉[1] 董家鸿[2] 

机构地区：[1]福建医科大学附属第一医院肝病中心,福州350004 [2]解放军总医院肝胆外科,北京100853

出　　处：《中华肝胆外科杂志》2009年第9期676-678,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：福建省青年人才项目（编号：2007F3030）

摘　　要：目的观察选择性胆管外引流在肝门部胆管癌根治性切除术中的价值。方法总结2000年1月至2008年1月收治的118例肝门部胆管癌的临床资料。结果选择性胆管外引流后行手术治疗25例，其中右肝管引流12例，左肝管引流10例，左肝外叶胆管引流1例，右后叶胆管引流2例；腹腔广泛种植转移1例，左或右半肝及尾状叶切除22例，扩大左肝切除1例，扩大右肝切除1例；术后胆漏3例，肺部及腹腔感染各1例，围手术期肝功能衰竭死亡1例；其余24例病人术后随访3个月至5年，平均23个月，其中最长的1例已存活4年4个月。结论选择性胆管外引流可以达到与全肝胆道外引流相似的改善肝功的目的，同时选择性胆管外引流也可以较安全的在肝门部胆管癌根治术予以应用。Objective To investigate the value of selective external biliary drainage in radical resection of hilar cholangiocarcinoma. Methods The clinical data of 118 patients with hilar cholangiocarcinoma treated in our hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of these 118 patients, 25 received selective external biliary drainage and operation. Amongst the 25 patients, 12 underwent external biliary drainage of right bile duct, 10 external biliary drainage of left bile duct, 1 external biliary drainage of left lateral bile duct and 2 external biliary drainage of right posterior bile duct. One patient had abdominal cavity implantation and metastasis. Twenty-two patients underwent resection of left or right liver and caudate lobe, 1 extended left liver and caudate lobe, 1 extended right liver and caudate lobe. Three patients suffered from bile leakage, 1 from pneumonia, 1 from abdominal cavity infection and 1 died of hepatic functional failure. The other 24 were followed up for 3 month to 5 years （mean.. 23 months）. One patient survived for more than 4 years and 4 months. Conclusion Selective external biliary drainage can not only improve as mush liver function as total external biliary drainage, but also be safe in radical resection of hilar cholangiocarcinoma.

关 键 词：胆管肿瘤 梗阻性黄疸 选择性引流 外科手术 

分 类 号：R686[医药卫生—骨科学]