腹腔镜肝门部胆管癌根治术8例临床体会  

Laparoscopic radical resection of hilar cholangiocarcinoma:Clinical experience of 8 cases

作　　者：张素芳 徐建波[1] 洪晟乾 李国安 严雨楼 祁付珍[1] ZHANG Sufang;XU Jianbo;HONG Shengqian;LI Guoan;YAN Yulou;QI Fuzhen(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huaian,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院肝胆胰外科,江苏淮安223300

出　　处：《肝胆胰外科杂志》2024年第5期276-281,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：江苏省医学重点学科培养单位(JSDW202233)。

摘　　要：目的探讨腹腔镜肝门部胆管癌根治术的可行性。方法回顾性分析2019年6月至2023年11月7例以及2024年1月1例于南京医科大学附属淮安第一医院行腹腔镜肝门部胆管癌根治术的共8例患者的临床资料,分析患者临床资料、手术情况及术后恢复情况。结果8例行腹腔镜肝门部胆管癌根治术的患者中,2例术前行经皮经肝胆管穿刺引流(PTCD)减轻黄疸,复查肝功能提示总胆红素降至80μmol/L以内后手术。Bismuth分型:Ⅰ型2例,Ⅱ型3例,Ⅲa型1例,Ⅲb型2例。手术方式:5例行腹腔镜肝门部肿瘤切除术,2例行腹腔镜肝门部肿瘤+左半肝+尾状叶切除术,1例行腹腔镜肝门部肿瘤+右半肝+尾状叶切除术。中位手术时间375(270~720)min,中位出血量350(200~800)mL,中位淋巴结清扫数7(3~11)个,R0切除率100%。术后8例患者平均引流管留置时间(11.0±2.5)d,平均镇痛时间(4.0±0.8)d,平均禁食时间(2.7±1.0)d,中位住院时间17(15~25)d,平均住院费用(7.8±2.2)万元。3例出现围手术期并发症,1例腹腔感染,1例A级胆瘘,1例上消化道出血,均经保守治疗后病情稳定,顺利出院。随访至2024年3月,中位随访时间16(2~48)个月。6例患者存活,2例因术后复发死亡,患者中位生存时间34个月。结论本临床中心的初步研究表明,通过精准的术前评估,腹腔镜肝门部胆管癌根治术是安全可行的。Objective To investigate the feasibility of laparoscopic radical resection of hilar cholangiocarcinoma.Methods This study retrospectively analyzed the clinical data of a total 8 patients,who underwent laparoscopic radical resection of hilar cholangiocarcinoma at the Affiliated Huaian No.1 People’s Hospital,7 cases from Jun.2019 to Nov.2023 and 1 case in Jan.2024.The patients’clinical data,operation conditions and postoperative recovery were analyzed.Results Among 8 cases,2 cases were treated with percutaneous transhepatic cholangial drainage(PTCD)before operation,operation can only be performed till the total bilirubin≤80μmol/L.Bismuth classification:typeⅠin 2 cases,typeⅡin 3 cases,typeⅢa in 1 case,and typeⅢb in 2 cases.Surgical methods:5 cases underwent laparoscopic resection of hilar tumors,2 cases underwent laparoscopic resection of hilar tumors+left half liver+caudate lobe,and 1 case underwent laparoscopic resection of hilar tumors+right half liver+caudate lobe.The median operation time was 375(270-720)min,the median bleeding volume was 350(200-800)mL,and the median number of lymph nodes cleaned was 7(3-11).The R0 resection rate was 100%.After operation,the average time of drainage tube indwelling was(11.0±2.5)d,average time of analgesia was(4.0±0.8)d,average time of fasting was(2.7±1.0)d,the median time of hospitalization was 17(15-25)d,and the average cost of hospitalization was(7.8±2.2)×104 yuan.Perioperative complications occurred in 3 cases,1 case of abdominal infection,1 case of biliary fistula with class A,and 1 case of upper gastrointestinal bleeding,all 3 cases were stable and discharged smoothly after conservative treatment.Patients were followed-up to Mar.2024,the median follow-up time was 16(2-48)months,6 patients survived and 2 died of postoperative recurrence,the median survival time was 34 months.Conclusion The preliminary study of this clinical center shows that,under accurate preoperative evaluation,laparoscopic radical resection of hilar cholangiocarcinoma is safe and fea

关 键 词：肝门部胆管癌 腹腔镜手术 三维成像 根治性切除 生存时间 

分 类 号：R735.8[医药卫生—肿瘤]