功能胆道外科理念在围肝门胆道恶性肿瘤根治性手术中的创新应用  

Application of functional biliary-tract surgical concepts in radical operation for perihilar malignant tumor

作　　者：姜楠[1] 赵国栋[1] 刘渠[1] 杨占宇[1] 丑赛 刘荣[1] Jiang Nan;Zhao Guodong;Liu Qu;Yang Zhanyu;Chou sai;Liu Rong(Faculty of Hepato- Pancreato- Biliary Surgery, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中华腔镜外科杂志（电子版）》2021年第5期277-281,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家重点研发项目(2017YFC0110405)。

摘　　要：目的探讨功能胆道外科理念在围肝门胆道恶性肿瘤应用的安全性及临床疗效。方法回顾性分析2020年10月至2021年6月解放军总医院第一医学中心的4例围肝门胆道恶性肿瘤根治术后胆管对端吻合重建手术患者的临床资料。结果4例手术中1例开腹手术、3例机器人手术完成;肝总管-胆总管对端吻合3例、左肝管-胆总管对端吻合1例;平均手术时间(217.5±65.5)min,平均术中出血量100 ml(50~200 ml),平均术后住院(9.3±3.6)d。其中1例腹水、1例胆瘘,无严重并发症。术后中位随访时间5.3个月(范围2~9个月)。4例患者肿瘤无复发表现,血液总胆红素、肿瘤标记物均正常。结论功能胆道外科理念在围肝门胆道恶性肿瘤的应用是安全、可行的,在保障患者病灶彻底切除的同时,充分保留了消化道结构和生理功能的完整性。Objective To explore the safety and clinical effect of application of functional biliary-tract surgical concepts in radical operation for perihilar malignant tumor.Methods From Oct.2020 to Jun.2021,the clinical data of 4 patients undergoing choledochocholedochostomy reconstruction with radical operation for perihilar malignant tumor was collected.Results Of 4 cases,1 case was performed laparotomy and 3 cases were robotic surgery.There were 3 cases of common hepatic duct to common bile anastomosis,and 1 case of left hepatic duct to common bile anastomosis.The mean operation duration was(217.5±65.5)min,the median intraoperative bleeding was 100 ml(50-200 ml),and the mean postoperative hospital stay was(9.3±3.6)days.Among the 4 cases,1 case was ascites and 1 case was biliary fistula.There were no serious complications.The median follow-up was 5.3 months(range 2 to 9 months).There was no recurrence of tumor in 4 patients,and blood total bilirubin and tumor markers were normal.Conclusions Application of functional biliary-tract surgical concepts in radical operation for perihilar malignant tumor is safe and feasible.The integrity of digestive tract structure and physiological function is fully preserved while the radical treatment of tumor is ensured.

关 键 词：功能胆道外科 肝门胆道恶性肿瘤根治 胆道重建 疗效 

分 类 号：R65[医药卫生—外科学]