胆囊癌肝胰十二指肠联合切除严重并发症分析与处理  

Analysis of serious complications following HPD of gallbladder cancer

作　　者：段伟宏 来运钢[1,2,3] 刘军桂 杨硕 刘翔 金奎 雷磊 

机构地区：[1]解放军火箭军总医院肝胆外科,北京100088 [2]邯郸市第一医院 [3]火箭军总医院

出　　处：《腹部外科》2016年第5期339-342,316,共4页Journal of Abdominal Surgery

摘　　要：目的探索肝胰十二指肠联合切除(hepatopancreatoduodenectomy,HPD)术对胆囊癌(NevinⅣ)的治疗价值。方法对19例胆囊癌病人行HPD术,术前酌情行门静脉栓塞(portal vein embolization,PVE),行经皮经肝穿刺胆道引流术(percutaneous transhepatic cholanic drainage,PTCD)减黄;观察术中、术后有无严重并发症及术后生存时间。结果19例HPD病人未出现术中大出血、死亡等并发症,但1例病人术后出现肺栓塞猝死,1例肝衰竭,1例术后出现严重的肺部感染死亡,其余病人不同程度出现胆瘘及胰瘘等并发症。结论HPD手术对胆囊癌达到R0切除有较大价值,能明显提高病人生存时间,但术后有严重的并发症及较高的病死率,需谨慎实施。Objective To explore the values of hepatopancreatoduodenectomy （HPD） in the treatment of the gallbladder carcinoma with Nevin stage IV. Methods From Jan. 2014 to July 2016, the clinical data of 19 cases of gallbladder carcinoma with Nevin stage ]V undergoing HPD were retro- spectively. Preoperative portal vein embolization （PVE） was performed in 4 patients and percutaneous transhepatic cholanic drainage（PTCD） was applied in 13 patients in order to improve the resectability. Peri- and posto-operativ complications and postoperative survival were observed. Results HPD was successfully performed on all 19 cases of gallbladder carcinoma without peri-operative massive bleed- ing, deaths, etc. Postoperatively, there was one death due to pulmonary embolism, one death due to hepatic failure, and one death due to severe pulmonary infection. Bile fistula and pancreatic fistula in the rest patents occurred to varying degrees. Conclusions HPD was of great value for gallbladder car- cinoma with R0 resection, and can obviously improve the survival, but should be cautiously per- formed.

关 键 词：胆囊癌 肝胰十二指肠切除术 黄疸 肝衰竭 

分 类 号：R657.4[医药卫生—外科学]