肝门部胆管癌患者的手术治疗  

The surgical treatment of hilar cholangiocarcinoma patients

作　　者：菅志远[1] 沈先锋[1] 周猛[1] 周平[1] 张敏[1] 兰明银[1] 

机构地区：[1]湖北医药学院太和医院普外科I科,湖北十堰442000

出　　处：《中国普通外科杂志》2011年第2期114-118,共5页China Journal of General Surgery

摘　　要：目的探讨影响可手术切除的肝门部胆管癌患者预后的相关因素。方法对6年间行手术切除的44例肝门部胆管癌患者的临床资料和生存情况进行回顾性分析。结果 44例手术切除的类型,R0切除38例,R1切除6例,R2切除0例。25例患者切除后采用了将空肠袢断端前壁与胆管残端开口上方肝脏断向缝合的新胆管空肠吻合方式,19例患者采用了传统的胆肠吻合方式,新的吻合方式较传统吻合方式可明显减低胆瘘的发生(χ2=4.565,P=0.033)。单因素分析显示,影响患者术后生存期的因素为肿瘤的临床分期、手术切除的范围、是否R0切除以及淋巴结是否转移;而多因素分析显示,影响生存的独立危险因素为肿瘤的临床分期和是否R0切除(P<0.05)。结论影响术后肝门部胆管癌生存期的因素为肿瘤的临床分期和R0切除;采用新的吻合方式,可在尽量减少正常肝组织切除的条件下,保证肿瘤切除的彻底性。Objective To explore the related factors that can influence the prognosis of patients with resectable hilar cholangiocarcinoma.Methods The clinical data and survival status of 44 cases of resected hilar cholangiocarcinoma,in our department in the latest 6 years,were analyzed retrospectively by univariate and multivariate analysis.Results Of all the 44patients,the R0,R1 and R2 resection was done in 38,6 and 0 cases,respectively.A new technique of hepaticojejunostomy,in which the anterior edges of the jejunal end were sutured to the liver above the opening of bile duct stump after suturing of posterior edges,was used in 25 patients,and the traditional hepaticojejunostomy technique was used in the other 19 patients;the bile leakage rate of the former techniqne was significantly less than that of the latter（χ2=4.565,P=0.033）.The clinical stage,extent of liver resection whether or not R0 resecion was done and lymph nodes metastasis were the factors that affected the survival with statistical difference by univariate analysis（P0.05）;while the clinical stage and whether or not R0 resection was done were the independent prognosis factors that affected the survival by multivariate Cox regression analysis（P0.05）.Conclusions The clinical stage and attainment of R0 resecion are the key factors that affect the prognosis of patients with resectable hilar cholangiocarcinoma;the new technique of hepaticojejunostomy is a useful measure which can decrease the resection extent of normal liver tissue while making sure that the tumor is completely resected.

关 键 词：胆管肿瘤/外科学 肝门部 胆管肠吻合术 预后 

分 类 号：R735.8[医药卫生—肿瘤]