不同类型肝切除术在中晚期胆囊癌治疗中的应用

Different types of hepatectomy for treating advanced gallbladder carcinoma

目的探讨中晚期胆囊癌累及肝脏的病理特点以及不同类型肝切除术的选择与安全实施的策略。方法回顾性分析1992年1月至2003年6月间43例的中晚期胆囊癌临床资料,总结分析手术中所涉及的肝切除术类型,并对癌肿累及肝脏与原发癌的不同临床病理因素的关系作统计分析。结果施行胆囊床肝脏楔形切除24例,S4a+S5肝段切除10例,S4+S5+S6肝段切除4例,右半肝切除5例。肝脏直接浸润的发生率为46.5%(20/43),主要累及S4a、S5或S6肝段。肝转移的发生率为20.9%(9/43),肝转移发生在S4及S5肝段可能性为56.3%(9/16)。中晚期胆囊癌肝脏受累与否与原发癌的部位、浸润深度、病理分级程度密切相关(P<0.05)。结论肝切除术是中晚期胆囊癌外科治疗中的一个重要组成部分,应根据肝脏受累的高危因素及受累肝段的分布特点,合理选择不同类型的肝切除术。

Objective To explore the clinicopathological features of advanced gallbladder carcinoma involved in hepar and the strategy of hepatectomy.Methods The clinical data of 43 cases of advanced gallbladder carcinoma underwent hepatectomy from January 1992 to June 2003 were reviewed.The types of hepatectomy were summarized and the relationship between clinicopathological factors and hepatic involvement was analyzed.Results In this group,24 cases underwent wedge hepatic resection,10 cases received S4a and S5 hepatic resection,4 cases received S4 and S5 and S6 hepatic resection,and 5 cases underwent right hepatectomy.The incidences of direct hepatic invasion and hepatic metastasis were 46.5% and 20.9%,respectively.Direct hepatic invasion occurred mostly in S4a or S5 or S6 and 56.3% metastases were located in S4 and S5.Hepatic involvement was significantly correlated with the depth of invasion,histological type and location of primary tumor (P<0.05).Conclusion Hepatectomy is one of the importantly surgical procedures in the treatment of advanced gallbladder carcinoma.Appropriate type of hepatectomy should be chosen according to the high-risk factors of hepatic involvement and the distributive characteristics of the involved lesions.