肝动脉切除重建和门静脉切除重建治疗肝门部胆管癌患者效果研究  

Prognosis of patients with hilar cholangiocarcinoma after reconstruction of hepatic artery or of portal vein and conventional radical hepatectomy

作　　者：孔庆利 张志生 梁志鹏 Kong Qingli;Zhang Zhisheng;Liang Zhipeng(Department of Hepatobiliary Gastrointestinal Surgery,Fourth Central Hospital Affiliated to Nankai University,Tianjin 300140,China)

机构地区：[1]南开大学附属第四中心医院肝胆胃肠外科,天津市300140

出　　处：《实用肝脏病杂志》2021年第1期127-130,共4页Journal of Practical Hepatology

基　　金：天津市自然科学基金资助项目(编号:16JCYBJC25200)。

摘　　要：目的探讨采取肝动脉切除重建和门静脉切除重建治疗肝门部胆管癌(HC)患者的临床效果。方法2014年3月~2017年1月我院收治的HC患者70例,采用随机数字表法分为A组24例,采取肝动脉切除重建的HC根治术治疗、B组23例,采取门静脉切除重建的HC根治术治疗和C组23例,采用常规根治术治疗。随访32~46(36)个月,比较术后1 a、2 a和3 a生存率。结果A组手术时间为(11.4±2.6)h,显著长于B组和C组【分别为(9.8±2.3)h和(9.2±1.2)h,P<0.05】,术中出血量为(914.5±175.0)mL,显著多于B组和C组【分别为(791.8±182.0)mL和(728.6±157.5)mL,P<0.05】,下床时间为(19.4±3.5)h,显著长于B组和C组【分别为(15.8±2.7)h和(15.5±2.3)h,P<0.05】,排气时间为(23.2±11.8)h,显著长于B组和C组【分别为(18.6±11.0)h和(19.0±11.1)h,P<0.05】,住院时间为(21.6±7.2)d,显著长于B组和C组【分别为(17.0±5.2)d和(16.2±4.4)d,P<0.05】;三组围术期并发症发生率分别为58.3%、56.5%和60.9%,差异无统计学意义(P>0.05);A组1 a、2 a和3 a生存率分别为66.7%、41.7%和33.3%,显著低于B组的91.3%、73.9%和52.2%(P<0.05)和C组的87.0%、69.6%和47.8%(P<0.05)。结论联合肝动脉切除重建的HC根治术并不比门静脉切除重建或常规根治术治疗HC患者能获得更好的中长期疗效,应慎重选择该术式治疗HC患者。Objective The aim of this study was to investigate prognosis of patients with hilar cholangiocarcinoma(HC)after reconstruction of hepatic artery or of portal vein and conventional radical hepatectomy.Methods 70 patients with HC admitted to our hospital between March 2014 and January 2017 were divided randomly into group A(n=24),receiving radical hepatectomy and hepatic artery resection and reconstruction,group B(n=23),receiving radical hepatectomy and portal vein resection and reconstruction,and group C(n=23),receiving conventional radical hepatectomy.All patients were followed-up for 32 to 46 months,with a median of 36 months.Results In group A,the operation time was(11.4±2.6)h,significantly longer than in group B and in group C[(9.8±2.3)h and(9.2±1.2)h,respectively,P<0.05],the intraoperative blood loss was(914.5±175.0)ml,significantly higher than in group B and in group C[(791.8±182.0)ml and(728.6±157.5)ml,respectively,P<0.05],the exhaust time was(23.2±11.8)h,significantly longer than in group B and in group C[(18.6±11.0)h and(19.0±11.1)h,respectively,P<0.05],the hospitalization stay was(21.6±7.2)d,significantly longer than in group B and in group C[(17.0±5.2)d and(16.2±4.4)d,respectively,P<0.05];the 1-year,2-year and 3-year survival rates in group A were 66.7%,41.7%and 33.3%,respectively,which were significantly lower than 91.3%,73.9%and 52.2%in group B(P<0.05)or 87.0%,69.6%and 47.8%in group C(P<0.05).Conclusion The combination of hepatectomy and reconstruction of radical hepatectomy is not superior to conventional radical surgery in the treatment of patients with HC,so we don’t recommend this procedure in clinical practice.

关 键 词：肝门部胆管癌 肝动脉切除重建 门静脉切除重建 常规根治术 

分 类 号：R735.8[医药卫生—肿瘤]