BismuthⅢ和Ⅳ型肝门部胆管癌的整块切除

En bloc resection for Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma

目的提高肝门部胆管癌的根治性切除率和远期生存率。方法对12例BismuthⅢ型和Ⅳ型肝门部胆管癌患者施行包括部分肝脏、受侵门静脉和肝动脉在内的整块切除。结果术后病理证实9例(75%)获根治性切除,3例(25%)为姑息性切除。术后发生胆漏、肝功能不全和肺部感染各1例,无严重并发症和手术死亡。中位随访5年。9例获根治性切除者1年、3年、5年存活率分别为88.8%(n=8)、55.6%(n=5)和44.4%(n=4),最长存活已达9年。获姑息性切除(n=3)和同期仅放置胆道内支架者(n=5),平均中位生存8.2和9.1个月。结论肝门部胆管癌合并左肝叶和受侵门静脉干联合整块切除能显著提高BismuthⅢ型和Ⅳ型肝门部胆管癌的根治性切除率。只有获得根治性切除的患者才有可能长期生存。

Objective To enhance the curative resectability rate and improve the prognosis of the patients with hilar cholangiocarcinoma.Methods Twelve patients with hilar cholangiocarcinoma,Bismuth type Ⅲ and Ⅳ,underwent an en bloc resection combined with partial liver and the invaded PV or both of PV and hepatic artery.Results Nine patients（75%） underwent curative radical resection and the others（n=3,25%） in the operation proved histologically were palliative.Perioperative complications occurred in three patients,including bile leakage（n=1）,ascites（n=1） and insufficient liver function（n=1）,no severe postoperative complications and no operative death occurred in this group.The median follow-up time lasts 5 years.1-year,3-year,5-year survival rate for those received radical resection was 88.8%（n=8）,55.6%（n=5） and 44.4%（n=4）,respectively.One patient has been survived free from tumor for more than nine years.But the mean survival time for the patients with palliative resection（n=3） and with biliary metallic stent placement（n=5） was only 8.2 and 9.1 months.Conclusion Conduction of en bloc resection of hilar cholangiocarcinoma with left hepatic lobectomy and removal and reconstruction of the invaded portal vein trunk are key to enhance the curative resectability for some Bismuth type Ⅲ and Ⅳ hilar cholangocarcinoma.Only those patients underwent curative resection can be expected to survive for a long period.