87例肝门部胆管癌手术切除的诊疗分析  

Diagnosis and treatment of surgical resection for 87 cases of hilar cholangiocarcinoma

作　　者：刘清华 汪凌 褚延魁 蹇泽英 康志龙[3] LIU Qinghua;WANG Ling;CHU Yankui;JIAN Zeying;KANG Zhilong(Department of General Surgery,Chongqing Infection Disease Medical Center,Pingdingshan Hospital District,Chongqing 400030;Department of General Surgery,Beijing Electric Power Hospital;Department of General Surgery,302 Hospital of People＇s Liberation Army,China)

机构地区：[1]重庆市公共卫生医疗救治中心平顶山院区普通外科,重庆400030 [2]北京电力医院普通外科 [3]解放军第302医院普通外科

出　　处：《胃肠病学和肝病学杂志》2018年第7期804-807,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析手术切除治疗肝门部胆管癌的疗效及技术要点。方法回顾性分析87例肝门部胆管癌患者行肝管高位切除及联合肝切除、肝肠吻合术及姑息性手术的临床资料。总结患者的手术方式,并发症发生情况,观察患者术后5年生存率。结果手术切除率为72.4%(63/87),姑息性引流率为27.6%(24/87)。术后病理结果均回报为胆管细胞癌,63例患者行手术切除,其中根治性切除(R0)占69.8%(44/63),姑息性切除(R1、R2)占30.2%(19/63),姑息性引流24例。围手术期死亡患者3例(2.3%),术后发生胆漏的患者13例(14.9%),术后发生应激性上消化道出血4例(4.6%),其他并发症如发生腹腔出血3例(3.4%),腹腔感染5例(5.7%),肝性脑病8例(9.2%),胸腔积液7例(8.0%),切口感染或裂开者6例(6.9%)。随访患者5年,根治性切除术组的患者5年生存率(28.4%)明显高于姑息性切除组(14.1%)及姑息性引流组(0)。结论肝门部胆管癌手术复杂,连同尾状叶的左、右半肝切除治疗肝门部胆管癌有助于提高根治性手术切除率,并能明显提高患者5年生存率。Objective To analyze the curative effect of surgical resection in the treatment of hilar cholangiocarcinoma and the main surgical skills. Methods The clinical data of eighty-seven patients with hilar cholangiocarcinoma were analyzed who received the hepatic duct high excision combined with liver resection and hepatoenterostomy. The surgical procedure,complications were summarizzed,and the postoperative 5-year survival rate was observed. Results Total surgical resection rate was 72. 4%（ 63/87）,the palliative drainage rate was 27. 6%（ 24/87）,postoperative pathological results were bile duct carcinoma in all patients. In 63 surgery patients,radical resection（ R0） accounted for 69. 8%（ 44/63）,palliative resection（ R1,R2） accounted for 30. 2%（ 19/63）. Palliative drainage was 24 cases. Perioperative death were 3 patients（ 2. 3%）,13 cases of bile leakage occurred after operation（ 14. 9%）,4 cases（ 4. 6%） occurred upper gastrointestinal bleeding. Other complications such as abdominal bleeding occurred in 3 patients（ 3. 4%） and celiac infection in 5 cases（ 5. 7%）,8 cases occurred hepatic encephalopathy（ 9. 2%）,pleural effusion was 7 cases（ 8. 0%）,and incision rupture or infection was 6 cases（ 6. 9%）. Follow-up of patients with 5 years,5-year survival rate was 28. 4%in radical resection group,significantly higher than that in palliative resection group（ 14. 1%） and palliative drainage group（ 0）. Conclusion The surgery of hilar cholangiocarcinoma is complexed,however,left and right liver resection along with the caudate lobe removal in the treatment of hilar cholangiocarcinoma is helpful to improve radical resection rate,and can significantly improve the 5-year survival rate.

关 键 词：肝门部胆管癌 肝管高位切除 尾状叶切除 半肝切除 肝肠吻合 

分 类 号：R575[医药卫生—消化系统]