1例Bismuth Ⅲa型肝门胆管癌的规范化手术治疗

Standardized surgical treatment for Bismuth type Ⅲa hilar cholangiocarcinoma:a case report

目的总结1例行肝门胆管癌(HC)根治术+门静脉部分切除重建+肝门胆管成形+胆管空肠Roux-en-Y吻合术的Bismuth Ⅲa型HC病例的诊治过程,并综述国内外关于HC手术治疗的发展现状。方法回顾性分析总结1例Bismuth Ⅲa型HC患者的临床资料。患者术前总胆红素水平为346.8μmol/L,行经皮肝胆管穿刺引流术(PTBD)减黄后,行HC根治术+门静脉部分切除重建+肝门胆管成形+胆管空肠Roux-en-Y吻合术。结果该例患者的总手术时间约为290 min,术中出血量约为350 mL,术中未输血。术后病理学检查示中分化胆管腺癌,切缘无癌细胞残留,淋巴结无转移(0/14)。术后患者未出现相关并发症,恢复顺利,于术后第9天出院。患者已在门诊随访3年,随访期间患者一般情况良好,未见复发或转移证据。结论术前减黄可提高手术安全性及降低术后并发症发生率,针对Bismuth Ⅲa型HC,扩大肝切除术可提高HC患者的R0切除率并且延长患者的术后生存期。

Objective To summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy,meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.Methods To retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma.The preoperative total bilirubin of this patient was 346.8μmol/L,and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage(PTBD).Then we retrieved domestic and foreign related literatures.Results Operative time of this patient was about 290min and intraoperative bleeding was about 350 mL.No intraoperative blood transfusion occurred.The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis(0/14).The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication.The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition.The evidence of recurrence or metastasis wasn’t found.Conclusions Preoperative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications,extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma,which can improve R0 resection rate and extend postoperative survival.