半肝联合肝动脉切除治疗BismuthⅢ、Ⅳ型肝门胆管癌43例  

Hemihepatectomy combined with hepatic artery resection for Bismuth Ⅲ, Ⅳ hilar bile ductcarcinoma：result of 43 cases

作　　者：张秋学[1] 刘汝海[1] 李学锋[1] 李风山[1] 杨冬山[1] 张执全[1] 张磊[1] 王铁功[1] 

机构地区：[1]沧州市中心医院普通外一科,河北省061001

出　　处：《中华普通外科杂志》2013年第11期819-821,共3页Chinese Journal of General Surgery

摘　　要：目的探讨半肝联合肝动脉切除治疗BismuthⅢ、Ⅳ型肝门胆管癌的效果和安全性。方法回顾性分析2003年5月至2012年6月半肝联合肝动脉切除的43例患者的资料，其中右半肝切除12例，左半肝切除28例，左三叶切除3例，联合尾状叶全部或部分切除19例，本组全部患者切除了肝固有动脉，联合门静脉部分切除重建5例，其中2例行肝动脉重建。年龄超过70岁且胆红素〉300μmol／L的5例患者术前行选择性引流减黄，时间2—3周。结果本组患者根治切除率58．1％（25／43）。病理类型：高分化腺癌5例，中分化腺癌13例，低分化腺癌18例，乳头状癌2例，黏液腺癌4例，硬化性腺癌1例，术后并发症发生率为39．5％（17／43），其中胆源性肝脓肿3例，胆瘘4例，肝功能不全合并大量腹水4例，门静脉重建后狭窄2例，肝动脉重建后闭塞1例，胃瘫3例，无手术死亡病例，1、3、5年存活率分别为93．O％（40／43）、39．5％（17／43）、27．9％（12／43）。结论肝门肝管癌侵及肝动脉时，受侵犯的血管多数已经狭窄甚至闭塞，因此，肝动脉切除是安全可行的，如果行门静脉切除重建时，肝动脉亦应同时重建。Objective To explore the effect and safety of combination of hemihepatectomy and hepatic artery resection for Bismuth Ⅲ, Ⅳ hilar cholangiocarcinoma. Methods A retrospective analysis was made on 43 cases operated from May 2003 to June 2012, including right hemihepatectomy in 12 cases, left liver resection in 28 cases, left trisegmentectomy in 3 cases, combined caudate lobe resection in 19 cases, all were with proper hepatic arterectomy, in those cases portal vein resection and reconstruction was carried out in 5 cases, hepatic artery reconstruction in 2 cases. Preoperative PTCD was performed in 5 cases in whom age 〉 70 and bilirubin 〉 300 p^mol/L. Results Radical resection rate was 58.1% （25/43）, 5 cases were well-differentiated adenocarcinoma, 13 cases of moderately differentiated adenocarcinoma, poorly differentiated adenocarcinoma in 18 cases, papillary carcinoma in 2 cases, mucous adenocarcinoma in 4 cases, sclerosing adenocarcinoma in 1 case, the incidence of postoperative complications was 39. 5% （17/43） including hepatic abscess （3 cases）, biliary fistula （4 cases）, hepatic insufficiency and massive ascites in 4 cases, portal vein stenosis after reconstruction in 2 cases, hepatic artery obliteration after reconstruction in 1 case, gastric paralysis in 3 cases. There was no inhospital death. 1, 3, 5 year survival rates were 93. 0% （40/43）, 39.5% （17/43）, and27.9% （12/43）. Conclusions In Bismuth III, IV hilar cholangiocarcinoma, in whom hepatic artery obliteration is common, hepatic arterectomy is safe and feasible, however, concurrent hepatic artery reconstruction is mandatory in those with the reconstruction of the portal vein.

关 键 词：胆管肿瘤 肝切除术 肝动脉 血管切除 

分 类 号：R735.8[医药卫生—肿瘤]