计划性肝切除在“中央型”肝内外胆管囊肿治疗中的应用  

Planned hepatectomy for the ＂central type＂ intrahepatic and extrahepatic choledochal cysts

作　　者：李斌[1,2] 邱智泉[1,2] 刘辰[1,2] 罗祥基[1,2] 程庆保[1,2] 冯飞灵[1,2] 徐畅[1,2] 吴越[1,2] 张柏和[1,2] 姜小清[1,2] 

机构地区：[1]第二军医大学东方肝胆外科医院胆道外科,上海200438 [2]第二军医大学胆道恶性肿瘤诊疗中心

出　　处：《中华肝胆外科杂志》2017年第9期619-623,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的回顾性分析计划性肝切除治疗“中央型”肝内外胆管囊肿的临床价值和优势。方法收集2014年1月至2017年4月于第二军医大学东方肝胆外科医院胆道外科进行计划性肝切除的7例“中央型”肝内外胆管囊肿患者的临床资料，并进行回顾性分析。结果7例患者均按照计划性肝切除治疗方案，成功实施了肝内外胆管囊肿根治性切除术。其中6例患者术前行经皮经肝胆管引流（PTCO）。实施选择性门静脉栓塞（PVE）5例，联合右半肝切除6例、联合左半肝切除1例。7例患者均合并慢性胆管炎。肝脏体积测定结果显示，PVE治疗后的拟切除（栓塞）肝叶体积显著缩小，而拟保留侧肝叶体积明显增大。PTCD和PVE相关并发症发生率均为0。患者术后平均住院时间为12d。所有患者围手术期肝功能均恢复良好。术后无出血、感染、肝功能衰竭等并发症，仅有1例患者出现胸腹腔积液。结论联合大部肝切除增加了“中央型”肝内外胆管囊肿手术并发症的风险。采用计划性肝切除治疗“中央型”肝内外胆管囊肿，能够提高手术安全性，降低患者术后肝功能衰竭及残余胆管囊肿等并发症的发生率，是有效可行的手术治疗策略。Objective To retrospectively study the clinical value and the advantages in ＂planned hepatectomy＂ for the ＂central type＂ intrahepatic and extrahepatic choledochal cysts. Methods The clinical data of 7 patients with the ＂central type＂ of intrahepatic and extrahepatic choledochal cysts which were trea- ted with ＂planned hepatectomy＂ from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University were retrospectively analyzed. Results All the patients completed radical resection of the intrahepatic and extrahepatic chole- dochal cysts in accordance with the ＂ planned hepatectomy＂. The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage （PTCD） and 5 patients with portal vein emboliza- tion （PVE） prior to the surgical excision. Combined right liver resection was performed in 6 patients, and combined left liver resection in one patient. All the 7 patients had a history of chronic cholangitis. Liver volume tests demonstrated that the hemiliver volume to be removed （the embolized hemiliver） significantly decreased after PVE, whereas the hemilivers to be persevered were remarkably enlarged. No complication associated with PTCD and PVE occurred. The mean postoperative hospitalization was 12 days. Liver function tests suggested all the patients recovered well. No postoperative complication of bleeding, infection or liver function failure was observed, except in one patient who experienced pleural and abdominal effusion. Con- clusions Combined subtotal hepatectomy may increase the risk of complications associated with the ＂central type＂ intrahepatic and extrabepatic choledochal cysts. The surgical strategy in planned hepatectomy can be used effectively to treat the ＂central type＂ of intrahepatic and extrahepatic choledochal cysts, with improved surgical safety, decrease in incidences of postoperative liver function failure and residual choledo

关 键 词：肝内外胆管囊肿 先天性胆管囊状扩张症 计划性肝切除 经皮经肝胆管引流 门静脉栓塞 

分 类 号：R657.4[医药卫生—外科学]