肝门空肠吻合术在肝门部胆管癌根治术中的应用价值  

Application value of portojejunal anastomosis in radical resection of hilar cholangiocarcinoma

作　　者：陈雪岩 孟兴凯[2] Chen Xueyan;Meng Xingkai(Graduate School of Inner Mongolia Medical University,Hohhot 010050,China;Department of Hepatobiliary Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学研究生院,呼和浩特010050 [2]内蒙古医科大学附属医院肝胆外科,呼和浩特010050

出　　处：《中华肝脏外科手术学电子杂志》2023年第4期440-443,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：内蒙古医科大学附属医院重大课题(NYFYZD2014005)。

摘　　要：目的探讨肝门空肠吻合术在肝门部胆管癌根治术中的应用价值。方法回顾性分析2011年12月至2021年12月在内蒙古医科大学附属医院治疗的8例肝门部胆管癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男5例,女3例;年龄45~69岁,中位年龄58岁。Bismuth-Corlette分型:Ⅱ型1例,Ⅲa 2例,Ⅲb 1例,Ⅳ型4例。患者行肝门部胆管癌根治术,胆道重建方式为肝门空肠吻合术。观察患者手术情况及术后并发症情况。结果8例患者均手术成功,无围手术期死亡。R0切除率为6/8。平均手术时间(245±37)min,术中出血量(350±100)ml,术后首次通气时间(2.5±0.7)d,术后住院时间(18±9)d。术后发生并发症2例,其中1例为胆漏,经充分引流、抗感染等保守治疗后痊愈;1例为肺部感染,经抗炎等治疗后痊愈。术后随访3周~24个月,1例患者术后6个月发生反流性食管炎,经保守治疗后症状减轻。1例患者因多器官功能衰竭于术后12个月死亡,1例患者因肿瘤腹腔转移于术后12个月死亡,2例患者因广泛肝内转移于术后16~24个月死亡。结论肝门空肠吻合术拓宽了肝门部胆管癌根治术的适应证,可提高根治性切除率、胆道重建成功率,降低术后胆漏发生率,且手术操作简单、易行、安全,尤其对多个肝管开口、内径较细、肝管开口相距较远甚至缩在肝内的患者更能显示出其优势。Objective To evaluate the application value of portojejunal anastomosis(Kasai procedure)in radical resection of hilar cholangiocarcinoma.Methods Clinical data of 8 patients with hilar cholangiocarcinoma treated in the Affiliated Hospital of Inner Mongolia Medical University from December,2011 to December,2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,5 patients were male and 3 female,aged from 45 to 69 years,with a median age of 58 years.According to Bismuth-Corlette classification,1 casewas classified as Bismuth-Corlette typeⅡ,2 cases of typeⅢa,1 case of typeⅢb and 4 cases of typeⅣ.All patients underwent radical resection of hilar cholangiocarcinoma,and biliary reconstruction was performed by using Kasai procedure.Surgical conditions and postoperative complications were observed.Results All 8 patients successfully underwent surgery.No perioperative death occurred.R0 resection rate was 6/8.The average operation time was(245±37)min,intraoperative blood loss was(350±100)ml,postoperative time to first flatus was(2.5±0.7)d,and the length of postoperative hospital stay was(18±9)d,respectively.Postoperative complications occurred in 2 cases,including 1 case of bile leakage who was cured after conservative treatment,such as adequate drainage and anti-infection.1 case with pulmonary infection recovered after anti-inflammatory treatment.During postoperative follow-up from 3 weeks to 24 months,1 patient developed reflux esophagitis at postoperative 6 months,and relevant symptoms were relieved after conservative treatment.1 patient died of multiple organ failure at 12 months after operation,1 patient died of abdominal metastasis of tumor at postoperative 12 months,and 2 patients died of extensive intrahepatic metastases from postoperative 16 to 24 months,respectively.Conclusions Kasai procedure can extend the indications for radical resection of hilar cholangiocarcinoma,elevate the radical resection rate and

关 键 词：胆管肿瘤 肝门空肠吻合术 Kasai手术 

分 类 号：R735.8[医药卫生—肿瘤]