Ⅲ型肝门部胆管癌的外科治疗(附35例分析)

Surgical treatment of Bismuth-Corlette Ⅲ cholangiocarcinoma(A report of 35 cases)

目的总结Ⅲ型肝门部胆管癌的手术经验。方法回顾性分析我院1999年1月至2006年12月,行手术切除的35例Ⅲ型肝门部胆管癌的临床资料。Ⅲa型16例,行肝门部胆管切除8例,行联合右半肝+右侧尾状叶切除7例,行联合右半肝+尾状叶切除、门静脉分叉部切除主干左支吻合1例。Ⅲb型19例,行肝门部胆管切除8例,行联合左半肝+左侧尾状叶切除9例,行联合左半肝+尾状叶切除、门静脉分叉部切除主干右支吻合1例,行联合左半肝+尾状叶切除、门静脉分叉部切除主干右支吻合、肝固有动脉分叉部切除主干右支吻合1例。结果本组32例获得随访,随访时间18～113个月。肝门部胆管切除病例术后病理根治性切除率为37.5%,联合肝叶切除病例术后病理根治性切除率73.7%,3例联合肝叶切除+血管切除病例均获术后病理根治性切除。肝门部胆管切除术后并发症发生率为31.3%,联合肝叶切除组术后并发症发生率为31.6%。3例联合肝叶切除+血管切除病例术后均无胆肠吻合口漏、肝断面坏死、胆漏等严重并发症。结论联合肝叶切除,必要时行受累分叉部血管切除重建,有益于提高Ⅲ型肝门部胆管癌的根治性切除率,且不增加术后并发症的发生率。

Obejective To summarize the experience in surgical treatment of Bismuth- Corlette Ⅲ cholangiocarcinoma. Methods A total of 35 consecutive patients of Bismuth-Corlette Ⅲ cholangiocarcinoma undergoing operation were retrospectively analyzed. Among the 16 cases of Bismuth-Corlette Ⅲa, 8 cases received local hilar bile duct resection, 7 cases received extrahepatic biliary tract resection combined with right hemi-hepatectomy and right partial caudate lobectomy, 1 case received extrahepatic biliary tract resection combined with right hemi-hepatectomy and right partial caudate lobectomy with portal vein bifurcation resection and reconstruction. Among the 19 cases of Bismuth-Corlette Ⅲb, 8 cases received local hilar bile duct resection, 9 cases received extrahepatic biliary tract resection combined with left hemi-hepatectomy and left partial caudate lobectomy, 1 case received extrahepatic biliary tract resection combined with left hemi-hepatectomy and left partial caudate lobectomy with portal vein resection and reconstruction, 1 case received extrahepatic biliary tract resection combined with left hemi-hepatectomy and left partial caudate lobectomy with portal vein and proper hepatic artery bifurcation resection and reconstruction. Results The pathological radical resection rate was 37.5% in patients received local hilar bile duct resection. The pathological radical resection rate was 73.7% in patients received extrahepatic biliary tract resection combined with hemi-hepatectomy and partial caudate lobectomy. All of the 3 patients received extrahepatic biliary tract resection combined with hepatectomy and partial caudate lobectomy with blood vessel resection were radically resected pathologically. The incidence of postoperative complications in patients received local hilar bile duct resection was 31.3%. The incidence of postoperative complications in patients received extrahepatic biliary tract resection combined with hepatectomy and partial caudate lobectomy was 31.6%. Conclusion Extrahepatic biliary tract resection combined with hepatectomy and partial caudate lobectomy and with blood vessel resection is helpful to enhance the radical resection rate of Bismuth-Corlette Ⅲ cholangiocarcinoma, and it doesn＇t increase the incidence of postoperative complication.