肝尾状叶胆管肿瘤和结石的外科治疗方式探讨  

Surgical treatment of cholangiocarcinoma or intrahepatic calculi in the caudate lobe

作　　者：刘宇斌[1] 胡伟贤[1] 林叶[1] 

机构地区：[1]广东省医学科学院广东省人民医院肝胆外科,广州市510080

出　　处：《实用医学杂志》2009年第24期4174-4175,共2页The Journal of Practical Medicine

基　　金：2008年广东省科技计划项目(编号:2008B36002026)

摘　　要：目的:探讨肝门部胆管癌和尾状叶肝管结石术中对尾状叶的外科治疗方式。方法:对1995年1月至2005年1月期间的25例因肝门部胆管肿瘤和尾状叶肝管结石而行肝尾状叶手术的患者进行随访和总结。结果:25例均行手术治疗,手术方式包括行肝门部肿瘤及尾状叶切除3例;肝门部肿瘤及尾状叶联合左半肝切除1例;因胆管结石行尾状叶联合左半肝切除3例;尾状叶联合左外叶切除3例;左右肝管切开,肝内胆管及尾状叶胆管取石,T管引流11例;左右肝管切开成形,肝内胆管及尾状叶肝管取石,空肠Roux-Y内引流术4例。无手术死亡,4例肝门部胆管癌患者中3例存活超过1年,1例超过3年;21例尾状叶肝管结石患者结石复发率为4.8%(1/21)。结论:肝门部胆管癌变常侵及尾状叶,其根治范围应包括肝尾状叶的切除;尾状叶肝管结石应切开左右肝管,力争术中取尽结石。Objective To explore the treatment of caudate lobe （luring the surgery for hilar cholangiocarcinoma or caudate lobe hepatic duct calculi. Methods We reviewed and analyzed the data of 25 patients who had undergone surgical treatment of caudate lobe from January 1995 to January 2005 due to hilar cholangiocarcinoma or caudate lobe hepatic duct calculi. Results Three patients had surgical resection of hilar cholangiocarcinoma and caudate lobe; one had caudate lobectomy combined with left hemihepatectomy for carcinoma; 3 had candatc lobectomy plus left hemihepatectomy for ealcuti; 3 had removal of left lateral lobe and caudate lobe ; 11 underwent ductal incision followed by intrahepatic and caudate duct stone extraction with T-tube drainage; 4 received duetal incision and repair followed by intrahepatic and caudate duct stone extraction with Roux-Y intestinal drainage. No death occurred. 3 of 4 patients with hilar cholangioeareinoma survived over one year and the remaining one survived more than 3 years. The recurrence rate of caudate lobe hepatic duct ealculi was 4.8% （1/21）. Conclusion In surgical treatment of hilar cbolangiocarelnoma, hepatic caudate lobe should be removed because of frequent invasion of the malignancy to the lobe ; while in the treatment of caudate lobe hepatic duct calculi, the right and the left hepatic duct should be incised followed by stone extraction.

关 键 词：胆结石 胆管肿瘤 肝尾状叶 手术 

分 类 号：R735.8[医药卫生—肿瘤] R657.3[医药卫生—临床医学]