扩大肝切除治疗Ⅲ、Ⅳ型肝门部胆管癌  

Extended hepatectomy in the treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma

作　　者：王冬冬[1] 鲁正[1] 吴维[1] 吴斌全[1] 吴华[1] 马翔[1] 孙万亮[1] 张登勇 崔培元[1] 谈燚[1] Wang Dongdong;Lu Zheng;Wu Wei;Wu Binqnan;Wu Hua;Ma Xiang;Sun Wanliang;Zhang Dengyong;Cui Peiynan;Tan Yi(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,233000

出　　处：《中华肝胆外科杂志》2018年第11期761-765,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省科技攻关项目（1604a0802088）

摘　　要：目的总结扩大肝切除治疗Ⅲ、Ⅳ型肝门胆管癌临床疗效和经验。方法回顾分析我科2008年1月至2016年6月73例行手术治疗的Bismuth-CorletteⅢ、Ⅳ型肝门部胆管癌患者临床资料。其中扩大肝切除术组行半肝及以上肝切除和（或）联合尾状叶切除术29例；局限肝切除术组行肝门区不规则肝切除术44例。结果扩大肝切除组患者相比局限肝切除组患者手术时间长、术中出血量多。扩大肝切除组患者并发症发生率低于局限肝切除组。扩大肝切除组无围手术期死亡患者，局限肝切除组有3例围手术期死亡。扩大肝切除组R0切除27例（93.1%），局限肝切除组R0切除24例（54.6%），两组差异具有统计学意义（P〈0.05）扩大肝切除组患者1、3、5年累积生存率分别为81.4%、51.4%、19.3%局限肝切除组分别为70.5%、24.4%、8.7%，两组差异具有统计学意义（P〈0.05）。结论经过充分的术前管理（主要是肿瘤和脉管的影像学评估、残余肝体积的计算、术前胆道的引流和肝功能的评估），扩大肝切除较局限肝切除具有较低的并发症发生率和围手术期病死率，同时具有较高的R0切除率和生存率，是一种比较合理的手术方式。Objective To study the effect of extended hepatectomy for hilar cholangiocarcinoma （HCCA） of the Bismuth-Corlette type Ⅲ and Ⅳ.Methods The clinical data of 73 patients with HCCA of the Bismuth-Corlette type Ⅲ and Ⅳ treated in our department from January, 2008 to June, 2016 were analyzed retrospectively. The extended hepatectomy group of patients consisted of 29 patients who underwent hepatectomy with half or more than half of the liver removed or/and combined with hepatic caudate lobectomy. The limited hepatectomy group consisted of 44 patients who underwent non-anatomical hepatectomy around the hepatic hilar region.Results Compared with the limited hepatectomy group, patients in the extended hepatectomy group had significantly longer operations with significantly more intraoperative blood loss. However, the complication rate was significantly lower than that of the limited hepatectomy group. There was no perioperative death in the extended hepatectomy group, while 3 perioperative deaths occurred in the limited hepatectomy group. The R0 resection rate was 93.1% （27 of 29） for the extended hepatectomy group, while it was 54.6% （24 of 44） for the limited hepatectomy group （P〈0.05）. The 1-, 3- and 5-year survival rates or the extended hepatectomy group were 81.4%, 51.4% and 19.3%, respectively while the corresponding rates for the limited hepatectomy group were 70.5%, 24.4% and 8.7%, respectively （P〈0.05）.Conclusions After adequate preoperative radiological assessments on tumor resectability, and the residual liver volumes, with preoperative biliary drainage to improve liver function, extended hepatectomy effectively increased R0 resection and survival rates with improved prognosis for patients with HCCA of Bismuth-Corlette type Ⅲ and Ⅳ.

关 键 词：肝门胆管癌 手术治疗 扩大肝切除 局限肝切除 预后 

分 类 号：R735.8[医药卫生—肿瘤]