“q”形胆管切开取栓术在肝细胞癌伴B4型胆管癌栓治疗中的应用价值  

Application value of"q-type"biliary thrombectomy in treatment of hepatocellular carcinoma with type 4 bile duct tumor thrombus

作　　者：陈伟钊 吴嘉艺 黄晓晓[1,2] 吕嘉晖 黄理铭 严茂林[1,2] CHEN Weizhao;WU Jiayi;HUANG Xiaoxiao;LU Jiahui;HUANG Liming;YAN Maolin(Fujian Medical University Provincial Clinical College,Fuzhou 350001,China;Department of Hepatobiliary Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建福州350001 [2]福建省立医院肝胆外科,福建福州350001

出　　处：《中国普通外科杂志》2021年第2期151-157,共7页China Journal of General Surgery

基　　金：福建省自然科学基金资助项目(2020J011105)。

摘　　要：背景与目的:肝癌(HCC)伴B4型胆管癌栓(BDTT)如何取栓目前尚无共识,因此,笔者对1例HCC伴B4型BDTT患者治疗经过进行总结回顾,以期为该病的治疗提供参考。方法:回顾性分析福建省立医院2019年3月收治1例HCC伴B4型BDTT患者临床资料,在术前精准评估后行手术治疗。术中采用“q”形胆总管切开取栓术,即纵行切开胆总管前壁至右肝胆管前壁,使BDTT完整暴露,再环行切断右肝胆管汇入肝总管处,完整切除肝外BDTT。分析患者术中、术后相关指标及随访情况。结果:该患者顺利完成右半肝切除+胆囊切除+“q”形胆管切开取栓+肝十二指肠韧带淋巴结清扫术。手术时间313 min,术中出血150 mL。病理学检查结果示,右肝肿物标本大小为4 cm×3 cm×3 cm,低分化HCC,侵犯肝包膜,可见脉管癌栓;胆总管癌栓为HCC。患者术后恢复顺利,无胆汁漏、腹腔感染、肝衰竭等并发症发生,术后第7天出院。随访14个月,患者生活质量良好,肿瘤无复发。结论:“q”形胆管切开取栓术是HCC伴B4型BDTT安全、有效、且符合无瘤原则的方法,推荐临床参考使用。Background and Aims:Th ere is no agreement on embolectomy for hepatocellular cancer(HCC)with type B4 bile duct tumor thrombus(BDTT)at present.Here,the authors report the treatment procedures of a patient with HCC and type B4 BDTT,so as to provide a reference for the treatment of this condition.Methods:Th e clinical data of one patient with HCC and type B4 BDTT treated in Fujian Provincial Hospital in March 2019 were reviewed.Th e patient underwent surgical treatment aft er accurate preoperative assessment.A“q-type”biliary tumor thrombectomy was performed during operation,which was namely,that a longitudinal incision from the anterior wall of the common bile duct to the anterior wall of the right hepatobiliary duct to completely expose the BDTT,and then a circular transection was made on the confluence of the right hepatic duct to the common hepatic duct to completely remove extrahepatic BDTT.The intra-and postoperative variables as well as the follow-up results were analyzed.Results:The patient underwent right hemihepatectomy,cholecystectomy,“q-type”biliary thrombectomy,and hepatoduodenal ligament lymph node dissection.All procedures were successfully completed.The operative time was 313 min and the intraoperative blood loss was 150 mL.Postoperative pathological results showed that the right liver tumor was poorly differentiated HCC with a size of 4 cm×3 cm×3 cm,and the presence of the hepatic capsular invasion,and microvascular tumor thrombus,and the tumor thrombus in common bile duct was HCC.The patient recovered smoothly without complications such as bile leakage,abdominal infection or liver failure.The patient was discharged from hospital on postoperative day 7.During the 14-month follow-up,the patient had a good quality of life,with no evidence of recurrence.Conclusion:For HCC type B4 BDTT,“q-type”biliary thrombectomy is a safe and effective procedure and it also adheres to the tumor-free operation principle.So,it is recommended to be applied in clinical practice.

关 键 词：癌 肝细胞 肿瘤细胞 循环 胆管 

分 类 号：R657.4[医药卫生—外科学]