肝门胆管癌根治术中用胃十二指肠动脉行肝动脉重建  

Hepatic artery reconstruction after hilar cholangiocarcinoma resection

作　　者：汪谢丹[1] 郑启昌[2] 尚丹[2] 沈新明[1] 吴瑞乔[1] 

机构地区：[1]武汉科技大学附属天佑医院普外科,430064 [2]华中科技大学协和医院肝胆外科

出　　处：《中华普通外科杂志》2010年第1期31-33,共3页Chinese Journal of General Surgery

摘　　要：目的总结胃十二指肠动脉代替肝动脉重建在肝门部胆管癌根治术中的应用经验。方法用顺性分析2004-2008年9例肝门部胆管癌根治术中，胃十二指肠动脉代替肝动脉重建临床资料及随访结果。结果9例行肝门部胆管癌根治术肝动脉切除超过1cm，利用胃十二指肠动脉代替肝动脉进行重建，其中1例联合门静脉部分楔形切除，自身大隐静脉移植修复，8例行肝内胆管支撑？9例术后全身炎症反应综合征于2—3d后明显缓解，1例术后3d出现上消化道出血治愈，无手术死亡和住院死亡。术后2周彩色超声监测显示重建肝动脉通畅。9例随访1～4年，中位生存期为23（6～32）个月：结论胃十二指肠动脉能较好地代替肝动脉重建，减少术后并发症的发生.Objective To summarize the clinical experience of hepatectomy with hepatic artery resection and reconstruction using gastroduodenal artery during radical resection of hilar cholangioearcinoma. Methods From Dec. 2004 to Dec. 2008, nine cases of hilar cholangioearcinoma with hepatic artery invasion were subjected to radical resection combined with tumor invaded hepatic artery resection and reconstruction using gastroduodenal anery. The clinical data of these patients were reviewed. Results Nine cases underwent hilar cholangiocarcinoma radical resection with hepatic artery resection, immediate hepatic artery reconstruction using gastroduodenal artery end to end anastomosis while hepatic artery resection exceeding 1 cm. One patient underwent partial resection of the portal vein and repair using autogenous segment of great saphenous vein. Roux-en-Y hepaticojejunostomy was performed in 9 patients with intrahepatic bile duct stents in 8 patients. All patients suffered from postoperative transient SIRS and recovered within 2 -3 days after operation. One patient experienced massive bleeding from the upper alimentary tract 3 day after operation and the bleeding was controlled afterwards. The blood flow in the reconstructed hepatic arteries monitored by Doppler was normal two weeks after operation. There was no inhospital mortality. 9 patients were followed up for 1 -4 years , the median survival time is 23 months （6 months to 32 months）. Conclusion Hepatic artery can be reconstructed using gastrnduodenal artery. during a radical resection of hilar cholangiocarcinoma, and hepatic artery, reconstruction decreases the postoperative complications.

关 键 词：胆管肿瘤 外科手术 肝动脉 

分 类 号：R735.8[医药卫生—肿瘤]