肝门部胆管癌根治性切除术48例临床分析

Experience from surgical resection for 48 cases of hilar cholangiocarcinoma

目的探索和总结提高肝门部胆管癌根治性切除率及远期疗效的方法。方法2003年1月至2007年12月对48例肝门部胆管癌进行手术切除，男性26例，女性22例，年龄38～72岁，平均年龄63．6岁。Bismuth—CorletteⅠ型4例、Ⅱ型10例、Ⅲa型9例，Ⅲb型11例、Ⅳ型14例。预计肝切除体积超过全肝体积50％的术前常规减黄，〉60％的行门静脉栓塞。术中远端胆管均切至胰腺平面，均行肝总动脉、肝固有动脉、肝左、右动脉、门静脉骨骼化及十二指肠及胰头后方淋巴结清扫。回顾性分析所有患者的临床资料，比较不同肝切除技术的根治切除率和远期疗效。结果术前19例行经皮经肝胆道引流术，2例行对侧门静脉栓塞术。手术方式包括未切肝或少量肝方叶组织切除8例，中央区域限量肝切除10例，扩大左半肝切除17例，扩大右半肝切除11例，肝中叶切除2例。术后病理显示远端胆管均获得阴性切缘，近端胆管阳性切缘5例。手术死亡1例。总体术后1、3和5年生存率分别为93．5％、51．8％和36．5％。扩大肝切除术后患者长期生存率显著高于限量肝切除和局部切除术（P=0．034）。结论扩大的肝切除术治疗肝门部胆管癌可以获得更好的预后。

Objective To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma. Methods The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively, There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old. Results Perioperative management ingcluding percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases. Eight patients were treated with extrahepatic bile duct resection with or without parital hepatic segment H resection, 10 cases with perihilar hepatic resection （segment IVB ,partial V ,partial vm, I ） ,28 cases with extended hemihepatectomy and 2 cases with central hepatic resection（segment IV B, V, Ⅷ, I ）. R0 resection rate was 89.5% and the operative mortality was 2. 1%. The 1-, 3- and 5-year survival rate were 93.5%, 51.8% and 36. 5%, respectively. Patients undergoing extended hepatic resection survived significantly longer than those undergoing partial hepatic resection （P = 0. 034）. Conclusions Extended hepatic resection for hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.