联合肝脏离断和门静脉结扎的二步肝切除技术并肝动脉重建治疗肝门部胆管癌  

Associating liver partition and portal vein ligation for staged hepatectomy combined with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma

作　　者：王要轩 李珂 田玉伟[1] 姜青峰[1] 申权[1] 贾江坤[1] 薛焕洲[1] Wang Yaoxuan;Li Ke;Tian Yuwei;Jiang Qingfeng;Shen Quan;Jia Jiangkun;Xue Huanzhou(Department of Hepatobiliary Surgery,Henan Province People＇s Hospital,Zhengzhou 450001,China)

机构地区：[1]河南省人民医院肝胆外科,郑州450001

出　　处：《中华肝胆外科杂志》2018年第9期600-603,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨联合肝动脉重建的联合肝脏离断和门静脉结扎的二步肝切除（ALPPS）在肝门部胆管癌治疗中的应用价值。方法回顾性分析7例接受联合肝动脉重建ALPPS手术的肝门部胆管癌患者临床资料，分析其技术要点，总结围手术期管理经验。手术方法：一期手术探查门静脉及肝动脉侵犯情况。判断肿瘤可切除后，结扎预切除侧门静脉，以超声乳化吸引刀（CUSA）离断肝脏，于第一肝门处离断胆管。快速病理确定切缘阴性后行胆肠吻合术。超声引导下经肝实质于预切除侧肝脏穿刺置入胆管引流管。2～3周后复查CT确定肝脏增生后切除肿瘤并重建肝动脉。结果7例患者均接受了二期手术，无围手术期死亡患者。其中6例出现肺部感染，均经保守治疗痊愈。2例患者一期术后出现胆漏继发腹腔感染，1例二期术后出现肝动脉血栓继发胆道感染。结论联合肝动脉重建的ALPPS治疗动脉受侵犯的肝门部胆管癌是一种安全可行的方法。Objective To study the combined use of ALPPS （ associating liver partition and portal vein ligation for staged hepatectomy） with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement. Methods The clinical data of 7 patients with hilar cholangiocarci- noma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively. The technical points and the perioperative management were analyzed. Methods At the first stage, the relationship between the tumor and the vessels were explored, the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA （ Cavitron Ultrasound Surgical Aspira- tor）. Then the bile duct was cut and a hepaticojejunostomy was completed. Finally, under ultrasound guidance, a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected. Two to three weeks later, and after enough hypertrophy of the liver remnant size was confirmed, tumor resection was completed with reconstruction of the hepatic artery. Results Seven patients underwent the second stage operation, with no perioperative death. Six patients developed pulmonary infection and were treated successfully with conservative treatment. Two patients developed postoperative bile leak with secondary abdominal infection. One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection. Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

关 键 词：肝门部胆管癌 肝动脉重建 联合肝脏离断和门静脉结扎的二步肝切除 

分 类 号：R735.8[医药卫生—肿瘤]