显微外科肝动脉重建在累及第一肝门胆管癌外科治疗的应用  

Application of microsurgical hepatic artery reconstruction in surgical treatment of cholangiocarcinoma involving the first porta hepatis

作　　者：韦德令 蒋佳君 徐邦浩[1,2,3] 王继龙 朱海 卢婷婷[4] 张灵 曾晶晶[6] 郭雅[2,3] 文张[2,3] Wei Deling;Jiang Jiajun;Xu Banghao;Wang Jilong;Zhu Hai;Lu Tingting;Zhang Ling;Zeng Jingjing;Guo Ya;Wen Zhang(Guangxi Medical University,Nanning 530021,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Key Laboratory of Basic Research of Accelerated Rehabilitation Surgery for Digestive Tract Tumors in Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Ultrasound,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Pathology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学,南宁530021 [2]广西医科大学第一附属医院肝胆外科,南宁530021 [3]广西消化道肿瘤加速康复外科基础研究重点实验室,南宁530021 [4]广西医科大学第一附属医院超声科,南宁530021 [5]广西医科大学第一附属医院放射科,南宁530021 [6]广西医科大学第一附属医院病理科,南宁530021

出　　处：《中华肝脏外科手术学电子杂志》2024年第3期350-356,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广西壮族自治区卫生健康委员会项目(20210962)。

摘　　要：目的 探讨显微外科肝动脉重建在累及第一肝门的肝内胆管癌(ICC-IFPH)和肝门部胆管癌(HCCA)的手术安全性和疗效。方法 回顾性分析2017年6月至2023年10月在广西医科大学第一附属医院确诊为ICC-IFPH或HCCA的11例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男6例,女5例;年龄44~73岁,中位年龄55岁。患者均接受肿瘤切除联合肝动脉切除和重建,观察患者围手术期资料和随访数据。结果 患者平均手术时间(541±154)min,出血量中位数696(200,1 900)ml;肝动脉重建时间(23±6) min,动脉内径(2.0±0.5)mm,切除长度(3.3±1.0)cm。术后肝动脉通畅率100%(11/11)。R0切除10例,R1切除1例。术后Clavien-Dindo并发症分级为Ⅲa级2例,其中1例术后发生胆漏、肝脓肿,另1例术后胰瘘。无发生术后肝衰竭、围手术期死亡。随访期间3例分别于术后3、10、48个月死亡。患者中位随访时间10个月,随访超过12个月以上有7例。结论 显微外科肝动脉重建在ICC-IFPH和HCCA的外科治疗中具有较好的安全性和可行性,为剩余肝脏提供了富氧动脉血,降低术后肝衰竭的发生,提高胆管癌手术切除率,有助于提高患者生活质量,改善患者的预后。Objective To evaluate the safety and efficacy of microsurgical hepatic artery reconstruction in the treatment of intrahepatic cholangiocarcinoma involving the first porta hepatis (ICC-IFPH) and hilar cholangiocarcinoma (HCCA).Methods Clinical data of 11 patients diagnosed with ICC-IFPH or HCCA in the First Affiliated Hospital of Guangxi Medical University from June 2017 to October 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,6 patients were male and 5 female,aged 44-73 years,with a median age of 55 years.All patients underwent tumor resection combined with hepatic artery resection and reconstruction.Perioperative data and follow-up data were observed.Results The average operation time was (541±154) min.The median blood loss was 696 (200,1 900) ml.The reconstruction time of hepatic artery was (23±6) min.The inner diameter of artery was (2.0±0.5) mm,and the length of resected artery was (3.3±1.0) cm.Postoperative patency rate of hepatic artery was 100% (11/11).R0 resection was performed in 10 cases and R1 resection in 1 case.According to the Clavien-Dindo classification,2 patients developed grade Ⅲa complications,including postoperative bile leakage and liver abscess in 1 case and pancreatic fistula in the other case.No postoperative liver failure or perioperative death occurred.During postoperative follow-up,3 patients died at postoperative 3,10 and 48 months,respectively.The median follow-up duration was 10 months,and 7 patients were followed up for over 12 months.Conclusions Microsurgical hepatic artery reconstruction is a safe and feasible procedure for ICC-IFPH and HCCA,which can provide oxygen-enriched arterial blood for the remaining liver,lower the incidence of postoperative liver failure,enhance surgical resection rate of cholangiocarcinoma,and improve the quality of life and clinical prognosis of patients.

关 键 词：显微外科 胆管癌 血管侵犯 肝动脉重建 外科治疗 

分 类 号：R735.8[医药卫生—肿瘤]