联合血管切除重建技术在肝门部胆管癌根治术中的应用  

Application of combined vascular resection and reconstruction for radical resection of hilar cholangiocarcinoma

作　　者：张潇 张中林[1] 李锟[1] 江平[1] 杨智勇 何跃明[1] 孙权[1] 刘志苏[1] 袁玉峰[1] Zhang Xiao;Zhang Zhonglin;Li Kun;Jiang Ping;Yang Zhiyong;He Yueming;Sun Quan;Liu Zhisu;Yuan Yufeng(Department of Hepatobiliary&Pancreatic Surgery,Zhongnan Hospital,Wuhan University,Hubei Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肝胆胰外科,湖北武汉430071

出　　处：《腹部外科》2021年第2期104-109,共6页Journal of Abdominal Surgery

基　　金：科技部国家重点研发计划重点专项(SQ2019YFC200078/02);武汉大学中南医院肿瘤研究与转化平台工程项目(ZLYNXM202004)。

摘　　要：目的探讨肝门部胆管癌根治术中联合血管切除重建的安全性和有效性。方法回顾性分析2014年6月至2019年12月武汉大学中南医院收治的113例确诊为肝门部胆管癌的病人,包括行姑息治疗50例(姑息治疗组),行开腹肝门部胆管癌根治术63例,其中行联合血管切除重建的肝门部胆管癌根治术26例(联合血管切除重建组),行常规肝门部胆管癌根治术37例(常规根治组)。比较常规根治组及联合血管切除重建组两组病人的手术时间、术中出血量、是否术中输血、术后肝功能恢复情况、术后严重并发症发生率、住院时间等围手术期情况以及两组病人术后90 d生存率,同时亦比较姑息治疗组、常规根治组、联合血管切除重建组三组病人术后1、3、5年的总生存率。结果联合血管切除重建组病人手术时间、术中出血量和术中输血率均高于常规根治性切除组(P<0.05),但在并发症发生率、住院时间以及术后90 d生存率差异无统计学意义(P>0.05);常规根治组在术后第1、3、5天丙氨酸转氨酶(ALT)以及术后第1、3天天冬氨酸转氨酶(AST)低于联合血管切除重建组(P<0.05),但在术后第7天的ALT值及术后第5天、第7天的AST值差异无统计学意义(P>0.05);此外两手术组病人术后1、3、5年总存活率差异无统计学意义(P>0.05),但两组病人术后1、3、5年总生存率均明显高于姑息治疗组(P<0.01)。结论在仔细评估、选择合适病例前提下,肝门部胆管癌根治术中联合血管切除重建是安全的,而且可获得与不需要血管切除重建的肝门部胆管癌手术病人相似的疗效,行根治性手术的病人疗效优于行姑息性治疗的病人。Objective To explore the safety and efficacy of combined vascular resection and reconstruction for radical resection of hilar cholangiocarcinoma(HC).Methods From June 2014 to December 2019,a total of 113 hospitalized HC patients were retrospectively analyzed.There were 50 cases of palliative treatment(palliative treatment group),63 cases of hilar cholangiocarcinoma undergoing vascular resection&reconstruction(n=26,vascular resection&reconstruction group)and 37 cases of hilar cholangiocarcinoma undergoing conventional radical operation(n=37,conventional radical resection group).Operative duration,intraoperative volume of blood loss/transfusion,postoperative recovery of liver function,incidence of postoperative serious complications,average hospitalization stay and 90-day survival rate of two groups were compared.Meanwhile,palliative treatment,conventional radical treatment and vascular resection&reconstruction groups were also compared.Also 1/3/5-year overall survival rates were compared.Results Operative duration,intraoperative volume of blood loss and intraoperative blood transfusion rate were higher in vascular resection&reconstruction group than those in conventional radical resection group(P<0.05).However,no significant difference existed in incidence of complications,average length of hospital stay or 90-day survival rate(P>0.05).The levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were lower in routine radical resection group than those in vascular resection&reconstruction group at Day 1/3/5 post-operation(P<0.05).However,no significant difference existed in ALT value at Day 7 post-operation or AST value at Day 5/7 post-operation(P>0.05);In addition,no significant inter-group difference existed in 1/3/5-year overall survival rate(P>0.05).However,the 1/3/5-year overall survival rates of two operative groups were significantly higher than those of palliative treatment group(P<0.01).Conclusion With careful evaluations and selection of appropriate cases,vascular resection and reconstruc

关 键 词：肝门部胆管癌 血管切除重建 安全性 疗效 

分 类 号：R735.8[医药卫生—肿瘤]