肝门胆管癌术后胆道系统并发症的防治  

Management for biliary complications in post-operation of hilar cholangiocarcinoma

作　　者：张秋学[1] 赵连利[1] 刘汝海[1] 李学锋[1] 杨冬山[1] 张执全[1] 李凤山[1] 张磊[1] 鲁猛[1] 

机构地区：[1]沧州市中心医院普通外科,河北061001

出　　处：《中华肝胆外科杂志》2014年第6期440-442,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝门胆管癌（Hcc）术后胆道并发症的发生原因和防治措施。方法总结我院1998年9月至2013年9月手术治疗的130例肝门胆管癌患者的病例资料。Bismuth分型：I型11例，Ⅱ型33例，Ⅲa型36例，inb型42例，Ⅳ型8例。手术方式：采用基本术式（胆囊、肝门部胆管和胆总管切除，肝十二指肠韧带“骨骼化”，肝门胆管空肠Roux—en-Y吻合）68例，基本术式联合右半肝切除14例、左半肝切除37例、左三叶切除3例、左半肝联合胰十二指肠切除2例，外引流6例。全尾叶或部分尾叶切除39例。联合肝固有动脉切除60例，其中6例重建。门静脉部分切除吻合12例。结果胆道并发症总发生率为26．2％（34／130）。其中胆漏21例，经引流后2周内愈合19例，4周后愈合2例。胆道感染7例，应用抗生素和利胆药物后痊愈。吻合口狭窄3例，其中2例再次手术治愈，1例肝内胆管穿刺引流后带管出院。胆汁瘤3例，经介入引流后痊愈。本组因肝功能衰竭死亡2例、多器官功能障碍综合征（MODS）死亡1例，病死率为2．3％（3／130）。结论肝门胆管癌术后胆道并发症发生率较高，其中胆漏发生率居众多并发症之首。合理引流是治疗胆漏的最佳方法。Objective To explore the reasons and preventive measures for biliary complications in post-operation of the hilar cholangiocarcinoma （ HCC ）. Methods From September 1998 to September 2013, we have performed operations for 130 eases of hilar bile duct carcinoma, who were classified into Ⅰ type 11 cases, Ⅱ type 33 cases, Ⅲ type a 36 cases, Ⅲ type b 42 cases, Ⅳ type 8 cases by Bismuth classification. Surgical procedure types included the basic operation type difined as excision with gallbladder, hilar and common bile duct, hepatoduodenal ligament ＂skeletonized＂, and hilar bile duct-jejunum Roux-en-y an- astomosis, with or without liver resection. Results The total incidence of biliary complications was 26. 2% （34/130）, 21 cases of biliary leakage, after drainage of the 19 cases healed in 2 weeks, 4 weeks after healing in 2 cases; 7 cases of biliary tract infection, use of antibiotics and cholagogue recovered drug; Stenosis in 3 patients, including 2 cases of reoperation cured, 1 case of intrahepatic bile duct after puncture drainage with tube discharge; Gallstone liver abscess （3 cases）, after intervention drainage of the whole. This group of 2 cases of death from liver failure, MODS, 1 case death. The mortality was 2. 3% （3/130）. Conclusions Biliary leakage ranked first in the incidence among biliary complications in post-operation of HCC, and drainage is the best solution for the treatment of biliary leakage.

关 键 词：胆管肿瘤 外科手术 并发症 胆漏 

分 类 号：R735.8[医药卫生—肿瘤]