第一肝门的骨骼化清扫治疗肝门部胆管癌

Skeletal clearing curing of the first hepatic hilar for cholangiocarcinoma

目的评价肝门胆管癌的根治性切除运用骨骼化清扫技术以减少并发症和提高手术效果的意义。方法回顾性分析1999年以来收治的80例肝门部胆管癌患者的临床资料,其中应用常规胆管癌切除技术32例(A组),应用胆管的骨骼化清扫技术48例(B组),比较其并发症和生存率状况。结果A组并发症发生率和围术期死亡率分别为37.5%和18.8%,B组则为27.08%和8.3%,两者比较差异有统计学意义(P<0.05)。B组的术后1年生存率明显提高(P<0.05)。结论第一肝门的骨骼化处理是提高肝门部胆管癌手术预后的关键,综合措施提高吻合口的安全性是预防术后胆漏发生的首要选择。

Objective To evaluate the significance of cholangiocarcinoma excision with skeletal clearing technology to decrease complication and enhance operation effect. Methods A retrospective analysis was performed in 80 cases of cholangiocarcinoma admitted after 1999 in our hospital. The cases were divided into two groups. 32 cases used routine resection technology （Group A）, and 48 cases dealed with skeletal clearing technology of cholangiocarcinoma （Group B）. The complication and survival rate were compared. Results Comphcation incidence rate of operation were 37.5% in Group A and 27.08% in Group B, mortality rate of operation stage were 18.8% or 8.3% respectively.The difference between two groups were significant （P 〈0.05）.Survival rate of one year obviously enhanced in group B （P〈0.05）. Conclusion The keys to improve operation of cholangiocarcinoma is excision of near liver duct with skeletal clearing technology, and chief choice of preventing gallbladder leak after operation is to heighten security of anastomose gap.