肝门部胆管癌手术中胃十二指肠动脉搭桥在肝动脉重建中的应用

Bypass reconstruction of hepatic artery using gastro-duodenal artery in radical operation for hilar cholan-giocarcinoma

目的总结胃十二指肠动脉搭桥重建肝动脉在肝门胆管癌根治术中的应用经验，为肝胆外科医生在肝门部胆管癌手术中正确运用动脉重建方法提供帮助。方法通过胃十二指肠动脉搭桥重建肝动脉的9例患者的临床资料、手术方法及随访结果，回顾分析伴有肝动脉受侵超过2cm的患者肝门部胆管癌根治术中重建肝动脉的临床资料。结果9例肝门部胆管癌手术，受累动脉均为肝右动脉，动脉受累长度均≥2cm；所有动脉重建手术均一次性吻合成功，平均吻合时间为（23．0±3．i）min。术后患者胃管引流量及胃肠蠕动功能均无异常表现，术后1周、1个月、3个月常规复查腹部增强CT，术后长期随访无动脉血栓等并发症形成。结论取胃十二指肠动脉移植物作搭桥重建肝动脉能够降低血管重建相关并发症，且对胃肠功能几乎没有影响，是肝门部胆管癌肝动脉重建的最佳选择。

Objective To summarize the clinical experience of hepatic artery bypass reconstruc- tion using gastroduodenal artery in radical resection of hilar cholangiocarcinoma,and to provide assis- tance for surgeons applying artery reconstruction technique correctly in radical operation of hilar cholangioearcinoma. Methods 9 cases of hilar cholangiocarcinoma with hepatic artery invasion were subjected to radical resection combined with tumor-invaded hepatic artery resection and reconstruction. Hepatic artery bypass reconstruction was performed by end to-end anastomosis, using the gastroduode nal artery interposition graft. The clinical data of these patients were reviewed retrospectively. Results All tumors of these cases with hilar cholangiocarcinoma were involved right hepatic artery, and the in volvement length was not less than 2 cm. The artery reconstruction was one-time successfully per- formed in all cases. The median time required for anastomosis was （23.0±3.1） min. No postopera- tive complications, the dysfunction of gastrointestinal peristalsis or abnormal gastric drainage volume for example, related to the gastro-duodenal artery resection was observed. None of the patients devel- oped any complications related to the arterial bypass reconstruction in the follow-up period, which was confirmed by abdominal CT scan. Conclusion Hepatic bypass reconstruction using gastro-duodenal artery graft decreases the morbidity related to artery reconstruction and has little effect on gastrointes- tinal function, which is the optimal choice for arterial reconstruction in radical operation for hilar cholangiocarcinoma.