腹腔镜半肝联合全尾状叶整块切除治疗肝门胆管癌2例并文献分析

Laparoscopic hemihepatectomy with en-bloc total caudate lobectomy in treatment of perihilar cholangiocarcinoma:A report of two cases and review of the literature

目的总结分析腹腔镜半肝联合全尾状叶整块切除(en-bloc)治疗肝门胆管癌的治疗经验。方法回顾性分析2017年4月和2017年9月浙江省人民医院肝胆胰外科行腹腔镜半肝联合全尾状叶en-bloc治疗肝门胆管癌的2例病人临床资料。结果 2例病例Bismuth-Corlette分型分别为ⅢA型和Ⅳ型。分别行右半肝联合全尾状叶切除术和左半肝联合全尾状叶切除术。无中转开放手术,无围手术期死亡。手术时间分别为520 min和680 min:出血量为800 m L和500 mL,未行血管重建,行胆肠端侧吻合。2例术中冰冻病理学检查均提示胆管切缘阴性。术后病理学检查结果均为腺癌,上下切缘均阴性,淋巴结阳性(0/12)及(1/9)。术后分别随访11、16个月,无复发,无术后胆肠吻合口狭窄。1例术后发生胆漏,经保守治疗治愈,无术后出血等其他并发症。结论腹腔镜半肝联合全尾状叶整块切除治疗肝门部胆管癌根治术在有经验的腹腔镜中心选择合适的病人是可以尝试施行的,但须临床数据进一步验证。

Objective To investigate the role of laparoscopie hemihepatectomy with en-bloc total caudate lobectomy in treatment of perihilar cholangiocarcinoma. Methods The clinical data of two cases of laparoscopic hemihepatectomy with en-bloc resection of total caudate lobe admitted in Zhejiang Provincial People＇ s Hospital between April 2017 and September 2017 were analyzed retrospectively. Results One case was type llI A of Bismuth-Corlette and another one is type IV. One case underwent right hemihepatectomy with en-bloe resection of total eauclate lobe and another one underwent left side resection. The operation time was 520 minutes and 680 minutes respectively. The estimated blood loss was 800 mL and 500mL. One patient had bile leakage. The follow-up period was 11 and 16 months, no recurrence or bilioenterostomy stricture was detected. The pathological results： introperative pathological results found all resection margins were clear. Postoperative results showed both cases were adenocarcinomas and lymphoid-node were （0/12） and （1/9）. Conclusion Laparoscopie henaihepateetomy with en-bloe total eaudate lobeetomy is safe and feasible in experienced center within selected patients,which need further clinical data and verification.