腹腔镜肝门部胆管癌根治术的临床疗效  

Clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma

作　　者：李德宇[1] 陶连元 潘玉进 余海波[1] 董亚东[1] 田广金[1] Li Deyu;Tao Lianyuan;Pan Yujin;Yu Haibo;Dong Yadong;Tian Guangjin(Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院肝胆胰腺外科,郑州450003

出　　处：《中华消化外科杂志》2020年第5期519-524,共6页Chinese Journal of Digestive Surgery

基　　金：河南省重点研发与推广专项(科技攻关)项目(192102310119);河南省科技厅科研项目(132102310096);吴阶平医学基金(LDWJPMF-104-2017005);河南省人民医院博士启动基金(ZC20180077)。

摘　　要：目的:探讨腹腔镜肝门部胆管癌根治术的临床疗效。方法:采用回顾性描述性研究方法。收集2017年1月至2019年7月河南省人民医院收治的25例肝门部胆管癌患者的临床病理资料;男16例,女9例;中位年龄为64岁,年龄范围为51~75岁。25例患者均行腹腔镜肝门部胆管癌根治术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者肿瘤局部复发情况和远处转移情况。随访时间截至2019年12月。正态分布的计量资料以±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果:(1)手术情况:25例患者中,15例BismuthⅠ型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+胆肠吻合术。2例BismuthⅡ型患者行腹腔镜肝门部胆管切除+围肝门切除+区域淋巴结清扫+胆肠吻合术。2例BismuthⅢa型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+右半肝切除+肝尾状叶切除+胆肠吻合术。3例BismuthⅢb型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+左半肝切除+肝尾状叶切除+胆肠吻合术。3例BismuthⅣ型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+肝尾状叶切除+胆肠吻合术。25例患者手术时间为(388±118)min,术中出血量为200 mL(50~2000 mL),术中输血6例。25例患者中,2例BismuthⅢa型患者手术时间,术中出血量分别为375 min、465 min,200 mL、1000 mL,术中输血1例;3例BismuthⅢb型患者手术时间,术中出血量分别为410 min、465 min、501 min,300 mL、400 mL、450 mL,均未予输血;3例BismuthⅣ型患者手术时间,术中出血量分别为415 min、560 min、600 min,300 mL、600 mL、800 mL,术中输血1例。(2)术后情况:25例患者中,术后发生Ⅰ级并发症4例,其中2例胆瘘(BismuthⅠ型1例,BismuthⅢa型1例),1例肺部感染(BismuthⅣ型)和1例术后肝功能不全(BismuthⅢa型),经保守治疗均好转。25例患者术后病理学检查结果:胆�Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma.Methods:The retrospective and descriptive study was conducted.The clinicopathological data of 25 patients with hilar cholangiocarcinoma who were admitted to Henan Provincial People′s Hospital from January 2017 to July 2019 were collected.There were 16 males and 9 females,aged from 51 to 75 years,with a median age of 64 years.All the 25 patients underwent laparoscopic radical resection of hilar cholangiocarcinoma.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Follow-up using out-patient examination and telephone interview was performed to detect local recurrence and distant metastasis of patients up to December 2019.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M(range).Count data were described as absolute numbers.Results:(1)Surgical situations:of the 25 patients,15 patients in Bismuth typeⅠunderwent laparoscopic radical resection of hilar cholangiocarcinoma+regional lymph node dissection+Roux-en-Y choledocho-jejunostomy,2 patients in Bismuth typeⅡunderwent laparoscopic radical resection of hilar cholangiocarcinoma+perihilar resection+regional lymph node dissection+Roux-en-Y choledochojejunostomy,2 patients in Bismuth typeⅢa underwent laparoscopic radical resection of hilar cholangiocarcinoma+regional lymph node dissection+right hemihepatectomy+hepatic caudate labectomy+Roux-en-Y choledochojejunostomy,3 patients in Bismuth typeⅢb underwent laparoscopic radical resection of hilar cholangiocarcinoma+regional lymph node dissection+left hemihepatectomy+hepatic caudate labectomy+Roux-en-Y choledochojejunostomy,3 patients in Bismuth typeⅣunderwent laparoscopic radical resection of hilar cholangiocarcinoma+regional lymph node dissection+hepatic caudate labectomy+Roux-en-Y choledochojejunostomy.The operation time was(388±118)minutes,and volume of intraoperative blood loss was 20

关 键 词：肝门部胆管肿瘤 根治 开腹 BISMUTH分型 住院费用 并发症 腹腔镜检查 

分 类 号：R735.7[医药卫生—肿瘤]