肝门血管骨骼化应成为T3,T4胆囊癌手术治疗的常规步骤

Vascular skeletonization of hepatic hilum should be an essential procedure in surgical treatment of T3,T4 gallbladder carcinoma

目的探讨肝门血管骨骼化胆囊癌根治术或扩大根治术对T3,T4胆囊癌的治疗价值。方法在连续收治的胆囊癌患者中,对16例术前或术中确诊的T3,T4胆囊癌随机分无肝门血管骨骼化的胆囊癌根治术或扩大根治术(n=9)、肝门血管骨骼化胆囊癌根治术或扩大根治术(n=7)2组。观察比较患者临床病理特征、术后并发症发生率及生存情况。结果两组患者年龄、性别分布、并发症发生率均无统计学差异;患者术后中位生存期分别为6和21个月,两组患者术后生存期比较统计学差异极显著(P=0.003 4),第2组7例患者中2例现仍无瘤生存。结论肝门血管骨骼化在外科治疗延长T3,T4胆囊癌患者生存中具有重要意义,应成为胆囊癌根治术的常规步骤。

Objective To evaluate vascular skeletonization of hepatic hilum （VSHH）in the treatment of T3,T4 gallbladder carcinoma（GC）. Methods Radical/extended radical resection without VSHH （n= 9）, and radical/extended radical resection with VSHH （n = 7） were employed randomly in 16 patients with T3,T4 GC. Clinicopathologic factors, postoperative complications and overall survival of the 2 groups of patients were compared. Results The mean survivals of patients after surgery were 6 and 21 months in the 2 groups respectively. There were no significant differences in the proportion of age, sex and postoperative complications between the 2 groups. The 7 patients who underwent radical or extended radical resection with VSHH showed significantly better survival than the group of patients in which VSHH was not carried out （P = 0. 003 4）.Of the 7 patients, 2 are still alive with tumor free at the time of the present study. Conclusions VSHH should be an essential surgical procedure and is a key to the improved survival of patients with T3, T4 GC undergoing radical or extended radical resection.