复杂肝门部胆管癌手术中的肝动脉重建技术  

Technique of reconstruction of hepatic artery with simultaneous left hepatectomy or trisectionectomy for complicated perihilar cholangiocarcinoma: report of 3 cases

作　　者：徐光勋 叶晟 项灿宏[1] 王开宇[1] 王良[1] XU Guangxun;YE Sheng;XIANG Canhong;WANG Kaiyu;WANG Liang(Department of Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,P.R.China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰中心/清华大学临床医学院,北京102218

出　　处：《中国普外基础与临床杂志》2022年第10期1273-1278,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨动脉受侵的复杂肝门部胆管癌手术中肝动脉重建的技巧。方法 回顾性分析清华大学附属北京清华长庚医院肝胆胰中心2022年3月至2022年7月期间收治的3例伴有动脉受侵的复杂肝门部胆管癌(即伴有肝动脉或同时有肝动脉和门静脉受侵者)行肝动脉重建患者的临床病理资料。结果 3例患者(病例1~3)均为男性,年龄分别为53、68、56岁,均伴有高血压或糖尿病,肿瘤长径分别为3.5、3.0、3.2 cm,均存在肝右动脉受侵,病例2和3存在动脉分层,根治性切除后动脉缺损长度分别为4.5、3和3 cm,分别用自体胃网膜右动脉移植间置、肝左动脉和胰十二指肠上前动脉重建后与肝右动脉或肝右后动脉吻合,术后彩色多普勒超声和增强CT血管造影检查监测重建的肝动脉通畅、无狭窄,未发生出血、感染、血栓形成等并发症。术后病理检查诊断为肝门部胆管癌伴动脉受侵,切缘均为阴性。结论 从本组病例结果看,肝门部胆管癌侵及肝动脉时,肿瘤连同受侵肝动脉一并切除后再选择合适的自体动脉重建缺损的肝动脉安全、可行,效果良好,但技术难度仍较高。Objective To explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. Method The clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. Results All 3 patients(case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes;the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion,and all the incisal edges were negative. Conclusion From the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery(matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.

关 键 词：复杂肝门部胆管癌 肝动脉受侵 肝动脉切除重建 显微外科技术 

分 类 号：R735.8[医药卫生—肿瘤]