肝动脉切除重建在肝门部胆管癌根治术中的应用

Hepatic artery resection and reconstruction in radical resection of hilar cholangiocarcinoma

目的探讨肝动脉切除显微外科重建在肝门部胆管癌根治术中的治疗经验和应用价值。方法回顾性分析2008年8月至2012年3月采用左半肝切除＋右肝动脉切除重建伴或不伴门静脉切除重建治疗肝门部胆管癌的7例临床资料。结果左肝动脉与右肝动脉吻合1例，右肝动脉与右肝动脉对端吻合1例，胃十二指肠动脉与右肝动脉吻合1例，肝固有动脉与右肝动脉吻合4例，伴门静脉切除重建2例。术后病理学检查：中一低分化腺癌2例，低分化腺癌3例，乳头状腺癌2例。手术：RO切除6例，R1切除1例。术后无肝功能衰竭、肝坏死、肝脓肿、胆肠吻合口瘘等并发症及围手术期死亡发生。结论肝动脉切除显微外科重建提高了进展期肝门部胆管癌的根治切除率，有效控制了术后并发症，安全可行。

Objective To evaluate hepatic artery resection and microsurgical reconstruction in radical resection of Klatskin＇s tumor. Methods We retrospectively reviewed clinical data of 7 patients with advanced hilar cholangiocarcinoma （Klatskin＇s tumor） who underwent left hemihepatectomy combined with right hepatic artery resection and microsurgical reconstruction with or without portal vein reconstruction from August 2008 to March 2012. Results Right hepatic artery was reconstructed with end-to-end anastomosis, using the reserved left hepatic artery （ n = 1 ）, the remanent right hepatic artery （n = 1 ）, the hepatic artery proper （ n = 4） and the gastroduodenal artery （ n = 1 ）, among those 2 patients underwent concomitant portal vein reconstruction. Post-operative pathology showed middle to low differentiated adenocarcinoma in 2 patients, low differentiated adenocareinoma in 3 and papillary adenocareinoma in 2. R0 resection was achieved in 6 patients. There was no post-operative liver failure, biliary-enteric anastomotic leakage or perioperative deaths. Conclusions Hepatic artery resection and microsurgieal reconstruction increases the radical resection rate of advanced hilar cholangiocarcinoma and decreases postoperative complications.