完全腹腔镜下肝门部胆管癌根治术14例经验总结

Experience of toatal laparoscopic radical resection of hilar cholangiocarcinoma: a report of 14 cases

目的探讨完全腹腔镜下肝门部胆管癌根治术的可行性、安全性及临床疗效。方法回顾性收集2016年4月至2018年6月期间徐州医科大学附属医院肿瘤外科行全腹腔镜下肝门部胆管癌根治术14例患者的临床资料并分析总结,其中BismuthⅠ型7例Ⅱ型5例Ⅲb型2例。结果 14例患者均顺利完成了全腹腔镜下肝门部胆管癌根治手术,手术时间为190～400 min(中位数为285 min),术中出血量为100～500 mL(中位数为175 mL);无围手术期死亡病例,术后病理学检查均提示胆管腺癌,切缘均为阴性;淋巴结检出数为6～15枚/例(中位数为8枚/例),3例患者存在肿瘤周围区域淋巴结转移;术后2例患者出现胆汁渗漏,其中1例合并腹腔感染,均保守治疗后痊愈出院。术后患者经3～24个月(中位随访时间16个月)的定期随访,1例术后12个月时肿瘤复发,其余患者至今生存良好。结论在有经验的腹腔镜医师操作下,全腹腔镜下肝门部胆管癌根治术是安全可行的,且近期效果较好。

Objective To investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods Retrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ,5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb. Results Total laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190-400 min(median time of 285min) and the amount of intraoperative blood loss was 100-500 mL(median amount of 175mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6-15 per case(median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3-24 months(median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far. Conclusion Under the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.