联合肝叶及血管切除重建根治术治疗肝动脉受侵肝门部胆管癌的近期随访  

Short-term follow-up of combined lobectomy with arterial resection and reconstruction for hilar cholangiocarcinoma

作　　者：朱学河 马丽杰[2] 吴魏 Zhu Xuehe;Ma Lijie;Wu Wei(Affiliated Hospital of Inner Mongolia Medical University,010050;Inner Mongolia Medical University,010050)

机构地区：[1]内蒙古医科大学附属医院,010050 [2]内蒙古医科大学,010050

出　　处：《中华普外科手术学杂志（电子版）》2020年第3期237-240,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：内蒙古自治区国家自然科学基金(2016MS08134)。

摘　　要：目的探讨联合肝叶及血管切除重建根治术治疗肝动脉受侵肝门部胆管癌(HCCA)的临床效果和预后情况。方法回顾性分析2016年10月至2019年10月肝动脉受侵HCCA患者98例资料,根据手术方式不同将患者分为联合组(HCCA根治术+肝叶切除+肝动脉切除重建术)51例和姑息组(姑息性胆管肿瘤切除术/内引流减黄手术)47例。所有数据均采用SPSS22.0软件处理分析,两组患者术中术后各项指标以(±s)表示,采用独立样本t检验。并发症比较采用χ^2检验;采用Kaplan-meier绘制患者的生存曲线;以P<0.05为差异有统计学意义。结果联合组手术时间、住院费用明显高于姑息组,但术中出血量、住院时间明显低于姑息组(P<0.05)。联合组并发症发生率为52.9%,与姑息组的42.6%比较,差异无统计学意义(P>0.05);两组均未发生围术期死亡。随访时间截至2019年11月,联合组的1年、2年、3年生存率分别为84.3%、66.7%、43.1%,,明显高于姑息组的17.0%、10.6%、4.3%(P<0.05)。结论联合肝叶及血管切除重建根治术用于治疗肝动脉受侵HCCA,可有效减少术中出血量,提高患者的生存率。Objective To investigate the clinical effect and prognosis of combined lobectomy with arterial resection and reconstruction for patients of hepatic artery invasion of hilar cholangiocarcinoma(HCCA).Methods 98 cases of HCCA with hepatic artery invasion from October 2016 to October 2019 were retrospectively analyzed.According to different surgical methods,the patients were divided into combined group(HCCA radical surgery+lobectomy+hepatic artery resection,51 cases)and palliative group(palliative bile duct tumor resection/internal drainage reduction surgery,47 cases).All the data were analyzed by spss22.0 software.The indexes of the patients in the two groups were expressed by,and independent sample t test was used to compare.The complications were compared byχ^2 test,Kaplan-Meier was used to plot the survival curve of patients,and P<0.05 was considered statistically significant.Results The operation time and hospitalization cost in the combined group were significantly higher than those in the palliative group.The intraoperative blood loss and hospital stay in the combined group were significantly lower than those in the palliative group,and the differences were statistically significant(P<0.05).The complication rate in the combined group was 52.9%,compared with 42.5%in the palliative group,the difference was not statistically significant(P>0.05);no perioperative death occurred in both groups.The follow-up time was up to November 2019.After 1 to 36 months of follow-up,all patients in the combined group had a one-year survival rate,a two-year survival rate,and a three-year survival rate of 84.3%,66.7%,and 43.1%,which were significantly higher than 17.0%,10.6%,4.3%in the palliative group,the differences were statistically significant(P<0.05).Conclusion The combined lobectomy with arterial resection and reconstruction can effectively reduce the amount of bleeding and improve the survival rate of patients with HCCA.

关 键 词：胆管肿瘤 肝切除术 血管切除 肝动脉 血管重建 肝门部胆管癌 

分 类 号：R73[医药卫生—肿瘤]