经肝前径路分离左、右肝治疗肝门部胆管癌的外科治疗体会

Extensive Resection of Hilar Bile Duct Using Transhepatic Approach for Hilar Cholangiocarcinoma

目的:探讨经肝前径路分离左、右肝治疗肝门部胆管癌的可行性和疗效。方法:回顾分析我院接受经肝前径路分离左、右肝治疗的9例肝门部胆管癌患者的临床资料。9例均术后病理证实为胆管腺癌,均因高龄、一般状况差、肝功不良等而不能耐受大部分肝切除。术中阻断半肝血流确认左右肝界限之后,在肝脏左右叶之间横断肝脏,切除2～3级胆管分支。结果:无围手术期死亡,1例发生胆漏住院时间延长。1例于术后9个月时因复发死亡,1例因心梗于术后8个月死亡。7例至今存活,其中5例存活超过10个月。结论:对于不能耐受肝切除的高位胆管癌患者,经肝前径路分离左、右肝切除胆管的方法是安全可行的,避免了肝脏切除,近期疗效可,远期疗效有待于进一步研究。

Objective：To investigate the feasibility and therapeutic results of extensive hilar bile duct resection using transhepatic approach.Methods：The clinical and pathological data were analysed in 9 patients with hilar cholangiocarcinoma and who were unfit for major hepatectomy for several reasons including old age,liver dysfunction,poor general condition.After identifying the demarcation line by hemilobar inflow vascular clamping,the liver parenchyma was transected along the Cantie line,then the resection of 2-3 grades bile duct could be easily achieved.Results：No perioperative death occurred but 1 patient suffered from biliary fistula that required a lengthy hospital stay.1 patient died after nine months for relapse while another 1 for myocardial infarction eight months postoperation.The other 7 patients are still alive,5 of which have survived more than ten months.Conclusion：Extensive hilar bile duct resection using transhepatic approach was feasible for those who were unfit for major hepatectomy.Long-term results after the operation needs further studies.