22例肝门部胆管癌外科手术治疗分析  

Surgical treatment of Hilar Cholangiocarcinoma: early results of 22 cases

作　　者：吴若林[1] 方翊天 陈灿灿 黄帆[1] 王国斌[1] 余孝俊[1] 侯刘进 叶征辉 赵红川[1] WU Ruo-lin;FANG Yi-tian;CHEN Can-can(The First Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院器官移植中心&肝胆胰二病区,合肥230032

出　　处：《肝胆外科杂志》2018年第6期414-418,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝门部胆管癌的外科手术治疗方式和效果。方法回顾性分析2016年1月至2018年9月期间于安徽医科大学器官移植中心&肝胆胰二病区接受外科手术治疗的22例肝门部胆管癌患者的临床病例资料。结果 22例肝门部胆管癌患者BismuthⅠ型1例(4. 5%),Ⅱ型2例(9. 0%),Ⅲa型9例(40. 9%),Ⅲb型3例(13. 6%),Ⅳ型7例(31.8%)。8例行术前减黄治疗。22例均接受根治性外科切除手术,其中半肝切除术14例,扩大半肝切除术2例,围肝门切除术6例,联合左尾状叶切除术3例,门静脉部分切除及修补术1例,肝动脉及门静脉切除重建术1例。术后病理证实中分化胆管细胞腺癌16例,低分化胆管细胞腺癌3例,中分化胆管粘液腺癌1例,低分化混合性肝癌1例,胆管细胞不典型增生1例。平均手术时间6. 8±1. 4小时;全组无围手术期死亡病例。术后发生并发症19例(86%),均经保守治疗治愈或好转后出院。术后18例患者得到完整随访,随访时间为3～28个月。随访期间死亡4例,死亡原因为术后肿瘤局部复发或肝内或全身转移。肿瘤局部复发及肝内转移4例,无瘤生存10例。最长无瘤生存时间28个月。结论根治性切除手术是治疗肝门部胆管癌最有效可行的外科治疗手段。Objective To review the clinical experience and evaluate the results in patients who underwent surgery for hilar cholangiocarcinoma.Methods Clinicopathological characteristics of 22 patients who underwent curative-intent resection for hilar cholangiocarcinoma at the Hepatobiliary Surgery Unit of the First Affiliated Hospital of Anhui Medical University between January 2016 and August 2018 were reviewed retrospectively,and operative detail,complication rate,and survival rate were also described.Results Most patients had hilar cholangioearcinoma with tumors classified as Bismuth-Corlette type Ⅲ and Ⅳ (54.5% and 31.8%).Preoperative biliary drainage was used in 8 patients.Liver resection performed along with extrahepatic biliary resection included 14 lobectomies (8 left,6 right)and 2 extended left lobe resection,3 patients also had simultaneous left eaudate resection,1 patient required portal vein and hepatic artery resection and reconstruction.The operation time was 6.8±1.4 h.The overall morbidity rate was 86% (19/22).18 patients were regularly followed up for 3 -28 months.During the follow-up period,4 patients dead,4 patients suffered from local tumor recurrence or liver metastasis,and 10 patients achieved tumor-free survival.The maxium tumor-free survival time was 28 months.Conclusion Radical resection can improve the survival of patients with hilar cholangioearcinoma.

关 键 词：肝门部胆管癌 肝切除术 术前减黄 血管重建 

分 类 号：R735.7[医药卫生—肿瘤]