根治性切除治疗肝门部胆管癌

RADICAL RESECTION FOR HILAR CHOLANGIOCARCINOMA-OUR EXPERIENCE

目的探讨肝门部胆管癌根治性切除的疗效及围手术期处理要点。方法回顾性分析2000年1月至2010年12月安徽医科大学第一附属医院肝胆外科收治的50例肝门部胆管行根治性切除(R0)患者的影像学资料、临床分型、病理特征、手术方式及随访情况。结果 50例患者中,依据Bismuth-Corlette分型,Ⅰ型者4例,Ⅱ型者11例,Ⅲa型者4例,Ⅲb型者18例,Ⅳ型者13例。影像学诊断准确性超声、CT以及MRCP术前检查的敏感性分别为82%(41/50),89.3%(25/28),95.7%(44/46)。联合肝叶切除27例,其中联合肝方叶切除5例,联合左半肝切除19例,联合右半肝切除3例,联合尾状叶部分切除2例,其中联合肝动脉切除4例。发生术后并发症14例(28%),围手术死亡1例(2.0%)。术后1、3和5年生存率分别为84%、28%、8%。结论肝门部胆管癌根治性切除提高疗效,术前应行影像学评估可切除性,术中要精细操作,确保胆管切缘阴性的R0切除并要抉择肝叶切除范围、血管切除与否及重建、尾叶切除等因素。

Objective To explore the therapeutic evalution of hilar cholangiocarcinoma （HCCA） with radical resection. Methods The data from 50 patients with HCCA who underwent radical resection between January 2000 to December 2010 were investigated retrospectively, which included clinical diagnosis, Bismuth-Corlette classification, pathologic features, surgical procedures and follow-up results. Results According to the Bismuth-Corlette classification,4,11,4,18, and 13 patients belonged to type I , 1] , m a, lllb and IV respectively. There were 27 cases underwent combined hepatic lobectomy. The 1 - ,3 - and 5 -year survival rates were 84% ,28% and 8% respectively . Postoperative complications rate was 28% with 2. 0% mortality rate. Conclusions The therapeutic evalution underwent RO radical resection could be significantly improved.