联合半肝切除与围肝门切除治疗肝门部胆管癌的疗效  

Curative Effect of Combined Hemihepatectomy and Perihilar Hepatectomy in Treatment of Hilar Cholangiocarcinoma

作　　者：李留峥 陆顺 张世荣 徐雷升 赵海荣 俸家伟 高学昌 吴彤 LI Liu-zheng;LU Shun;ZHANG Shi-rong;XU Lei-sheng;ZHAO Hai-rong;FENG Jia-wei;GAO Xue-chan;WU Tong(Dept,of Hepatobiliary Surgery,Lincang People fs Hospital,Lincang Yunnan 677000,China)

机构地区：[1]临沧市人民医院肝胆外科,云南临沧677000

出　　处：《昆明医科大学学报》2021年第10期121-126,共6页Journal of Kunming Medical University

基　　金：云南省万人计划基金资助项目(ynwr-my-2018051)。

摘　　要：目的总结不同手术切除方式治疗肝门部胆管癌(HCCA)的疗效。方法回顾性分析2015年1月至2020年12月临沧市人民医院施行手术治疗的52例HCCA患者的临床资料。其中采用半肝/扩大半肝+全尾叶切除36例(联合半肝切除组),肝门部/围肝门区+全尾叶切除16例(围肝门切除组),对比分析2组患者的术前资料,术中出血量、手术时间,肿瘤标本切缘阳性率、术后住院时间、术后3个月CA19-9值,以及术后1、3 a生存率等指标。结果联合半肝切除组与围肝门切除组的术中出血量[(705.5±54.3)mL vs(809.9±61.4)mL]、手术时间[(240.4±22.5)min vs(358.1±31.1)min]、肿瘤标本切缘阳性率(8.3%vs 18.8%)、术后3个月CA19-9值阴性率(88.2%vs 73.3%)以及术后1 a生存率(58.8%vs 40.0%),差异均有统计学意义(P<0.05)。结论联合半肝切除与围肝门切除均是HCCA的有效手术方式,但前者具有更高的R0切除率及短期生存率等优势。Objective To summarize the curative effect of different surgical resection methods for hilar cholangiocarcinoma(HCCA).Methods The clinical data of 52 patients with HCCA who underwent surgery in Lincang people’s Hospital from January 2015 to December 2020 were retrospectively analyzed.Among them,36 cases were treated with hemihepatectomy/extended hemihepatectomy+total caudate lobectomy(combined hemihepatectomy group),16 cases of hilar/perihilar region+total caudate lobectomy(perihilar resection group),The preoperative data,intraoperative blood loss,operation time,positive rate of tumor margin,postoperative hospital stay,CA19-9 value at 3 months after operation,and 1,3-year survival rate of the two groups were compared and analyzed.Results The indexes of the combined hemihepatectomy group and perihepatectomy group were as following:the intraoperative blood loss[(705.5±54.3)mL vs(809.9±61.4)mL],the operation time[(240.4±22.5)min vs(358.1±31.1)min],the positive rate of tumor resection margin(8.3%vs 18.8%),the negative rate of CA19-93 months after operation(88.2%vs 73.3%),and the 1-year survival rate(58.8%vs40.0%).The difference was statistically significant between the two groups(P<0.05).Conclusion Combined hemihepatectomy and perihilar hepatectomy are effective surgical methods for HCCA,But the former has higher R0 resection rate and short-term survival rate.

关 键 词：肝门部肿瘤 肝切除术 预后 

分 类 号：R735.7[医药卫生—肿瘤]