门静脉切除重建在肝门部胆管癌手术切除中的应用分析  

Patients with perihilar cholangiocarcinoma resection combined with portal vein resection and reconstruction

作　　者：陆才德[1] 吴胜东[1] 房炯泽[1] 黄静[1] 卢长江[1] 叶盛 江伟[1] 毛书奇 Lu Caide;Wu Shengdong;Fang Jiongze;Huang Jing;Lu Changjiang;Ye Sheng;Jiang Wei;Mao Shuqi(Department of Hepatopancreatobiliary Surgery,Ningbo Medical Center Lihuili Hospital,Ningbo 315041,China)

机构地区：[1]宁波市医疗中心李惠利医院肝胆胰外科,宁波315041

出　　处：《中华肝胆外科杂志》2022年第5期356-361,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：宁波市医疗卫生品牌学科资助(PPXK2018-03)。

摘　　要：目的研究联合门静脉切除重建在肝门部胆管癌手术切除中的价值。方法回顾分析2006年10月至2019年12月宁波市医疗中心李惠利医院肝胆胰外科行肝门部胆管癌切除的104例患者资料,其中男性63例,女性41例,年龄(64.4±10.4)岁。单纯行肝门部胆管癌切除的75例患者纳入对照组,联合保留侧门静脉切除重建的肝门部胆管癌切除29例患者纳入联合组。分析门静脉切除重建情况。比较两组手术相关指标、术后并发症、再手术、死亡情况。随访生存情况。Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果门静脉楔形切除侧侧吻合2例,节段切除端端吻合27例。门静脉切除重建时间(12.7±2.9)(时间范围8~18)min,门静脉切除长度(20.7±7.3)(长度范围8~38)mm。联合组术中出血量[M(Q_(1),Q_(3))]800.0(600.0,1500.0)ml、淋巴结转移58.6%(17/29),高于对照组的[M(Q_(1),Q_(3))]600.0(500.0,1000.0)ml、32.0%(24/75),差异均有统计学意义(均P<0.05)。术后Clavien-DindoⅢ级及以上并发症发生率为31.7%(33/104),其中对照组为30.7%(23/75),联合组为34.5%(10/29),再手术率和术后90 d死亡率对照组分别为9.3%(7/75)和2.7%(2/75),联合组分别为3.4%(1/29)和0,两组比较差异均无统计学意义(均P>0.05)。对照组术后1、3、5年累积生存率分别为81.1%、44.8%、36.4%,联合组为78.1%、35.9%、31.4%,两组比较差异无统计学意义(χ^(2)=0.33,P=0.570)。结论与单纯肝门部胆管癌切除相比,联合门静脉切除重建并未增加术后并发症发生率和死亡率,术后生存率相近。门静脉切除重建可用于经选择的肝门部胆管癌切除。Objective To study the safety and efficacy of combining portal vein resection and reconstruction(PVR)with resection of perihilar cholangiocarcinoma(PHC).Methods A total of 104 patients with PHC who underwent hepatectomies for either biliary resection alone or biliary resection combined with PVR from October 2006 to December 2019 at the Department of Hepatopancreatobiliary,Ningbo Medical Center of Lihuili Hospital entered into this study.There were 63 males and 41 females,with the age of(64.4±10.4)years.The control group consisted of 75 patients who underwent biliary resection alone,while the PVR group consisted 29 patients with biliary resection combined with PVR.The patient characteristics and the follow-up outcomes of the two groups were analyzed and compared.Survival analyses were performed using the Kaplan Meier method with the log-rank test.Results Wedge resection of portal vein,side to side anastomosis in 2 cases,segmental resection and end to end anastomosis in 27 cases.The time taken for PVR and portal vein resection were(12.7±2.9)(range 8 to 18)min and(20.7±7.3)(range 8 to 38)mm,respectively.The estimated blood loss for the PVR group was significantly more than the control group[M(Q_(1),Q_(3))]800.0(600.0,1500.0)ml vs.600.0(500.0,1000.0)ml(P<0.05).Based on postoperative pathological studies,the proportion of lymph node metastasis was significantly higher in the PVR group than the control group(58.6%vs.32.0%,P<0.05).Clavien-Dindo gradeⅢand above complications were 30.7%(23/75)and 34.5%(10/29)in the control and PVR groups,respectively(P>0.05).The re-operation and postoperative 90 days mortality rates were 9.3%(7/75)and 2.7%(2/75)in the control group,compared with 3.4%(1/29)and 0 in the PVR group,respectively(both P>0.05).The 1-,3-and 5-year survival rates were 81.1%,44.8%and 36.4%respectively for the control group and 78.1%,35.9%and 31.4%for the PVR group(χ^(2)=0.33,P=0.570).Conclusion When compared to biliary resection alone,biliary resection combined with PVR did not significantly increase postoper

关 键 词：Klatskin肿瘤 外科手术 手术后并发症 联合门静脉切除重建 生存 

分 类 号：R735.8[医药卫生—肿瘤]