肝门部胆管癌切除术不同手术方式的选择

Individualized Surgical Procedure of Resection for Hilar Cholangiocarcinoma

目的探讨肝门部胆管癌切除术不同手术方式的选择. 方法近五年来我院共收治肝门部胆管癌25例,其中手术切除17例,切除率为68%,参照Bismuth-Corlette分型选择不同的手术方式,包括Ⅰ型(肝总管癌)5例,Ⅱ型(汇合部肝管癌)3例,Ⅲa型(肝总管、右肝管癌)4例,Ⅲb型(肝总管、左肝管癌)4例,Ⅳ型(左或右肝管癌侵犯二级以上肝管)1例. 结果术后发生胆漏5例,均于手术后5～30 d自愈;发生膈下感染2例, 经引流治愈;术后出血2例, 其中1例因出现肝衰、DIC死亡,1例经用止血药、输血后痊愈.目前存活7例,平均生存25(12～42)个月.全组病例1、2、3年生存率分别为75.0%(12/16)、31.2%(5/16)、25.0%(4/16).结论肝门部胆管癌手术根治性切除应根据肿瘤的分型选择不同的术式.

Objective To study individualized surgical procedure of resection for hilar cholangiocarcinoma. Methods Individualized surgical procedure were indicated for the resection of hilar cholangiocarcinoma basing on Bismuth-Corlette classification. 25 cases of hilar cholangiocarcinoma were treated surgically in late 5 years, among which 17 cases were resectable and classified as type Ⅰ in 5 cases, type Ⅱ in 3 cases,type ma in 4 cases,type Ⅲb in 4 cases,and type Ⅳ in 1 case, the resection rate was 68%. Result Bile leakage occurred in 5 cases and were conservatively cured within 5 to 30 days postoperatively. Subphrenic infection occurred in 2 cases and were cured by drainage. 2 cases had postoperative hemorrhage and I died of liver failure and DIC. Follow-up showed average survival was 25（ 12 -42） months in 7 cases who survived till the date. 1, 2, and 3 year survival rate were 75.0% （12/16） ,31.2% （5/16） and 25.0% （4/16）respectively. Conclusion In terms of radical surgery for hilar cholangiocarcinoma, procedure should be individualized according to the tumor classification.