Bismuth Ⅳ型肝门部胆管癌根治术  

Radical resection of hilar cholangiocarcinoma in Bismuth type Ⅳ

作　　者：倪其泓[1] 张赟和 陈炜[1] 王坚[1] 

机构地区：[1]上海交通大学医学院附属仁济医院胆胰外科,200127

出　　处：《中华消化外科杂志》2016年第4期380-384,共5页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划课题（2012BA106801）

摘　　要：目的探讨Bismuth Ⅳ型肝门部胆管癌根治术的手术方法和临床疗效。方法采用回顾性描述性研究方法。收集2014年10月上海交通大学医学院附属仁济医院收治的1例Bismuth Ⅳ型肝门部胆管癌患者的临床资料。患者因反复右季肋区疼痛半月余入院，腹上区增强CT检查示肝门部低密度软组织影，术前精准评估后行肝门部胆管癌根治性切除＋右半肝切除＋围肝门切除＋右尾状叶切除＋胆管空肠Roux-en-Y吻合术。观察患者手术时间、术中出血量、病理学检查结果、术后并发症、引流管拔除时间、术后出院时间、随访情况。术后采用门诊和电话方式进行随访，随访内容为患者生命质量和肿瘤复发情况，随访时间截至2015年7月。结果患者顺利完成肝门部胆管癌根治性切除＋右半肝切除＋围肝门切除＋右尾状叶切除＋胆管空肠Roux-en-Y吻合术。手术时间为480min，术中出血量为300mL。病理学检查结果示肝门部胆管癌标本大小为4cm×3cm×2cm，低分化腺癌；浸润全层至肝组织，浸润门静脉右支；检测2枚第8组淋巴结，1枚第12a组淋巴结，3枚第12p组淋巴结均为阳性；见癌细胞转移，肝脏及各胆管切缘均为阴性，达到心切除。患者术后恢复顺利，无胆瘘、腹腔感染、肝衰竭等并发症发生，术后7d拔除负压引流管，术后12d出院。随访9个月患者生命质量良好，肿瘤无复发。结论患者术前精确的评估、合理的手术路径、个体化的手术方案和精细的术中操作可提高Bismuth Ⅳ型肝门部胆管癌的根治性切除率。Objective To investigate the surgical method and clinical efficacy of hilar eholangio- carcinoma in Bismuth type IV. Methods The retrospective descriptive study was adopted. The clinical data of 1 patient with hilar cholangioearcinoma in Bismuth type IV who was admitted to the Renji Hospital affiliated to Shanghai Jiaotong University in October 2014 were collected. The patient had complaint about right upper abdominal pain for half month. Enhanced CT scan showed soft-tissue mass at hepatic hilum. After accurate assessment, the patient underwent radical resection of hilar cholangiocarcinoma ＋ right hemihepateetomy ＋ perihilar resection ＋ right caudate hepatectomy ＋ Roux-en-Y hepaticojejunostomy. The operation time, volume of intra- operative blood loss, results of pathological examination, postoperative complications, time of drainage tube removal, discharge time and follow-up were observed. The follow-up was performed to detect the life quality and tumor recurrence by outpatient examination and telephone interview up to July 2015. Results The patient received successful radical resection of hilar eholangiocarcinoma ＋ right hemihepatectomy ＋ perihilar resection ＋ right caudate hepatectomy ＋ Roux-en-Y hepaticojejunostomy. Operation time and volume of intraoperative blood loss were 480 minutes and 300 mL, respectively. The result of pathological examination showed that the size of hilar bile duct was 4 cm × 3 cm × 2 cm and poor-differentiated adenocarcinoma infiltrated through bile duct into liver tissues and right branch of portal vein. Two lymph nodes in the 8th group, 1 in the 12a group and 3 in the 12p group were positive by detection, showing the metastasis of cancer cells. The resection margins of liver and bile ducts were negative, achieving a R0 resection. The patient had a removal of negative pressure drainage tube at postoperative day 7 and discharged from hospital at postoperative day 12, with a good recovery and without the complications of biliary fistula, abdominal infection and hepat

关 键 词：胆道肿瘤 肝门部 BISMUTH Ⅳ型 根治术 

分 类 号：R735.8[医药卫生—肿瘤]