联合尾叶的规则性肝叶切除术治疗肝门部胆管癌

Anatomic hepatectomy with caudate lobectomy for hilar cholangiocarcinoma

目的探讨如何提高肝门部胆管癌根治性切除率和生存率的方法。方法回顾性分析8年余收治的58例肝门部胆管癌行联合尾叶和规则性肝叶切除术患者的临床资料。结果肿瘤切除联合行规则性左半肝切除26例,规则性右半肝切除25例,右三肝切除4例,中肝叶切除3例;所有患者同时附加全尾叶切除手术和肝十二指肠韧带淋巴结骨骼化清扫。根治性切除率为72.4%(42/58)。1,3年生存率分别为79.5%和36.2%。有3例现已无瘤存活6年。结论肿瘤切除联合尾叶的规则性肝叶切除可以提高肝门部胆管癌根治性切除率和术后生存率;熟练掌握手术技巧是关键。

Objective To explore a method to improve the radical resection and survival rate of hilar cholangiocarcinoma. Methods Fifty-eight consecutive patients with hilar cholangiocareinoma who underwent anatomic hepatectomy together with caudate lobectomy from Feb 1998 to June 2006 were studied retrospectively. Results Tumor resection combined with anatomic left hemihepatectomy was performed in 26 patients, combined with anatomic right hemihepatectomy in 25 patients, with right hepatic trisectionectomy in 4 patients, and with middle hepatectomy in 3 patients. The entire caudate lobe was resected and skeletization lymph node dissection of the hepatoduodenal ligament was performed in all cases. The radical resection rate was 72.4 % （42/58） , and the 1-,and 3-year survival rate was 79.5 % , and 36.2 % respectively. At present, 3 cases have tumor-free survival for 6-year. Conclusions Tumor resetion combined with anatomic hepatectomy and caudate lobectomy can offer a better chance of long-term survival in some selected patients with advanced hilar cholangiocarcinoma. Skilled surgical technique can result in better outcomes.