目的

探讨手术切除治疗肝门部胆管癌的技术方法及临床意义。

方法

对58 例肝门部胆管癌患者采用肝十二指肠韧带脉络化、肝管高位切除及联合肝切除施行手术治疗,将肝断面诸肝管开口整形至1～2 个较大开口后施行肝管空肠吻合,难以整形者施行肝实质空肠吻合。

结果

术后病理均诊断为胆管腺癌, 高、 中、 低分化分别为21 例、18 例和19 例。 其中R0 级52 例(89.7%),R1 级6 例(10.3%)。 发生胆漏8 例,反流性胆道感染3 例,联合左半肝切除者发生肝衰竭死亡1 例。 术后随访53 例,随访率为91.4%(53/58),术后生存期1～10 年, 1、3、5 年总体生存率分别为75.5%(40/53)、45.3%(24/53)、26.4%(14/53)。

结论

肝十二指肠韧带脉络化有助于增加手术彻底性,肝管高位切除及联合肝切除有助于提高手术切除率和手术疗效。

Objective

To evaluate the surgical approaches and their clinical effects for hilar cholangiocarcinoma.

Methods

Fifty-eight patients underwent the surgical procedures of skeletonzation for hepatic artery and portal vein, high level resection of hepatic ducts and concomitant hepatic lobectomy or segmentectomy. Hepaticojejunostomy was performed after hepatic duct forming, with others undergoing hepatojejunostomy.

Results

Histological grade was classified as high differentiation in 21 patients, moderate in 18, and low in 19. Fifty-two patients (89.7%) were verified R0 curative resection, and surgical margin was positive in 6 patients (10.3%). 8 cases of bile leakage were observed. Regurgitation cholangitis occurred in 3 patients. One patient undergoing combined left hemihepatectomy died postoperatively from hepatic failure. Fifty-three patients had been followed up for 1 to 10 years. The 1-, 3-, 5-year survival rate was 75.5% (40/53), 45.3% (24/53), and 26.4% (14/53), respectively.

Conclusions

Skeletonzation resection for hilar cholangiocarcinoma may improve surgical curative efficacy. High level resection of hepatic ducts and concomitant lobectomy or segmentectomy of liver may improve resection rate and therapeutic effect.