精准右半肝联合肝尾状叶切除术治疗肝门部胆管癌

Precision right hemihepatectomy combined with hepatic caudectomy for the treatment of hilar cholangiocarcinoma

扩大肝切除可提高部分肝门部胆管癌患者的长期生存率.2013年5月川北医学院附属医院为1例Ⅲa型肝门部胆管癌患者运用精准肝脏外科的现代理念与临床精细的手术操作完成右半肝联合全尾状叶切除术.术中间断阻断第一肝门3次,手术历时8h,术中出血量约600 mL,患者于术后第14天出院.病理检查结果示右半肝肝门部胆管中高度分化腺癌,浸润管壁全层,切缘无癌残留.术后随访6个月未见肿瘤复发.该手术是在综合应用三维立体重建技术、肝脏储备功能评估、术中控制性低中心静脉压以及精细肝切除操作技术下进行,取得满意效果.

Extended liver resection may provide longterm survival in selected patients with hilar cholangiocarcinoma.In May 2013,a patient with hilar cholangiocarcinoma received right hemihepatectomy combined with caudate lobectomy under the guidance of precision hepatectomy technique.The porta hepatis was clamped in the operation for 3 times intermittently.The operation time was 8 hours,and the volume of intraoperative blood loss was 600 mL.The patient was discharged at postoperative day 14.The results of pathological examination confirmed that the patient had moderately-highly differentiated adenocarcinoma with full-thickness infiltration of the bile duct and tumorfree margins.No tumor recurrence was detected during the followup which was lasted for 6 months.The operation was carried out based on the three dimensional reconstruction,liver reserve function evaluation,intraoperative controlled low central venous pressure and precision hepatectomy technique,and the results were satisfactory.