提高肝门胆管癌切除率的探讨

Study on improving resection rate of klatskin's tumor

该院连续收治肝门胆管癌１７例。由于手术器械（ＰＭＯＤ）和肝切开术（刮吸法）的改进，１４例得以切除，切除率达８２．３％。按照Ｂｉｓｍｎｕｔｈ分型，Ⅰ型２例、Ⅱ型５例、Ⅱａ５例、Ⅲｂ４例、Ⅳ型１例。切除的病例中，伴右半肝切除２例，伴左半肝切除２例，伴Ⅳ段切除２例，单纯肝正中裂切开８例。１７例中实施“骨骼化”切除３例。切除的１４例随访６～３６月，４例死亡，其余存活。文中简要介绍了用刮吸法切开肝正中裂的手术步骤和要点。肝外胆管切除后，肝面遗留的肝管开口应与空肠作Ｒｏｕｘ－Ｙ吻合。文中还介绍了“拼缝”、“运河”、“肝盆”等手术方法。

Seventeen consecutive cases of klatskin's tumor were treated in this hospital from March,1992 to November,1994.Owing to the employment of a new instrument(PMOD)and a new technique for hepatotomy(curettage and aspiration),the turnor was resected in 14 cases with a resection rate of 82.3%;According to Bismuth's typing,there were 2 cases in type Ⅰ,5 in type Ⅱ,5 in type Ⅲa,4 in type Ⅲb,and 1 in tyupe Ⅳ. Among those with tumor resected,concomitant right hemihepatetoy was done in 2 cases, left hernihepatectomy in 2 cases,Ⅳ segment hepatectomy in 2 cases,splitting of medium fissure in 8 cases.'Skeletonization'was carried out in 3 cases,The 14 casex with ,tumor resected were followed up from 6 to 3 6 months.4 cases died,the other 10 survive.To provide adequate exposure,the:authors emphasize the importance of splitting of medium fissure and the technique is also described briefly in thits paper.