肝门胆管癌70例临床诊治分析  

Surgical treatment of patients with hilar cholangiocarcinoma in a single center

作　　者：张登勇 孙万亮[1] 马翔[1] 鲁正[1] 吴斌全[1] 吴华[1] 王冬冬[1] 刘中 崔培元[1] Zhang Dengyong;Sun Wanliang;Ma Xiang;Lu Zheng;Wu Binquan;Wu Hua;Wang Dongdong;Liu Zhong;Cui Peiyuan(The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,安徽省蚌埠233000

出　　处：《中华医学杂志》2019年第4期284-287,共4页National Medical Journal of China

基　　金：安徽省科技攻关项目(1604a0802088).

摘　　要：目的总结探讨肝门胆管癌(HCC)术前评估、手术规划、术后治疗的临床体会。方法回顾性分析蚌埠医学院第一附属医院肝胆外科2011年1月至2017年12月70例HCC患者的临床资料,从术前评估及处理,手术方法,术后恢复及预后3个方面探讨我们对该病种的治疗体会。结果三维重建对HCC的精准评估有利于手术方案的制定;扩大半肝切除或联合尾叶或门静脉切除术对于Ⅲ、Ⅳ型HCC效果显著,R0切除率达93%(53/57);术后病理示高/中/低分化腺癌分别为21/30/16例,腺瘤2例,炎症病变1例,腺癌患者经术后化疗1年生存率达87%(60/69),3年生存率达47.0%(31/66),5年生存率达30.2%(19/63)。结论HCC患者经过术前充分评估实施根治性手术后结合静脉化疗,可获得较好的预后;扩大肝切除可提高Ⅲ~Ⅳ型HCCA患者的R0切除率,改善预后。Objective To study the experience of preoperative evaluation, surgical planning and postoperative treatment of hilar cholangiocarcinoma (HCC) in our center. Method The clinical data of 70 patients with HCC who underwent resection at the First Affiliated Hospital of Bengbu Medical College, from January 2011 to December 2017 were analyzed retrospectively. The treatment experience of HCC from the aspects of preoperative evaluation and treatment, surgical methods, postoperative recovery and prognosis were discussed. Results The accurate evaluation of HCC by three-dimensional visualization technology was beneficial to the formulation of surgical plan preoperatively. Extended hemihepatectomy or combined resection of caudate lobe or portal vein was effective for type Ⅲ-Ⅳ HCC. The R0 resection rate was 93% (53/57). Postoperative pathology showed that high/middle/low differentiated adenocarcinoma of 21/30/16, adenoma in 2 cases, inflammatory lesion in 1 case. The 1/3/5-year overall survival rates of patients with adenocarcinoma after chemotherapy were 87%(60/69)/47.0%(31/66)/30.2%(19/63) respectively. Conclusion HCC patients who under radical surgery after preoperative evaluation and postoperative chemotherapy can obtain a good prognosis. Expanding hepatectomy can improve R0 resection rate and prognosis in patients with type Ⅲ-Ⅳ HCC.

关 键 词：肝门部胆管癌 三维成像 肝切除术 

分 类 号：R735.8[医药卫生—肿瘤]