肝门部胆管癌的外科治疗

Surgical Treatment of Hilar Bile Duct Carcinoma

肝门部胆管癌切除率很低,作者在1991年前收治17例中仅切除1例,切除率5.9%。此后,采用了附加肝叶的扩大切除,9例病人切除4例,切除率为44.4%,较前明显提高。本组无围术期死亡,存活期明显延长。作者强调B超在诊断上的重要作用。对梗阻性黄疸鉴别诊断时要充分考虑该病的可能性。主张早期手术,认为术前PTBD弊多利少。作者改进了胆肠吻合的缝合方法,避免了吻合口胆漏,同时指出提高切除率的另一关键是施术者的决心和经验。应多争取一期切除。

Carcinoma of the bile duct at the liver hilum is not rare but its re-sectability is low. Before 1991, out of 17 cases only one was resected (5. 9%). However,from 1992 to March 1995.four of 9 cases which were explored were resected with satisfying postoperative survival (44. 4%). No operative mortality took place. Stress was put on the importance of B-US in differential diagnosis of obstructive jaundice. Preoperative PTBD in the author's view is of little value. It is thought that the increase of resectability was due to the increase of surgical aggressiveness including hepatic segmentectomy and lobectomy as well as radical dissection of hepato-duodenal ligament. Advance of the suturing technique in hepato-bil-iary-jejunal anastomosis played a role in preventing leakage from occurrence.