肝门部外科技术在肝外胆管癌术中的应用

EXPERIENCE OF HILAR SURGICAL TECHNIQUES ON EXTRAHEPATIC CHOLANGIOCARCINOMA.

目的 探讨在肝外胆管癌切除术中如何合理应用肝门部外科技术。方法 分析自 95年至 2 0 0 0年 6月 2 8例行手术治疗的肝外胆管癌资料 ,按手术技术的不同划分为两个组 :未应用肝门部外科技术组 (95 - 98年 )和应用肝门部外科技术组 (99- 2 0 0 2年 6月 ) ,每个组各有 14例。 结果 经合理地应用肝门部外科技术后 ,肝外胆管癌的切除主由未应用肝门部外科技术组的 2 1.5 %提高到应用肝门部外科技术组的 6 4 .3% ,切除病例无 1例术后死亡。结论 在胆管癌切除手术中肝门部外科技术的关键技术是游离肝门板并尽快实施胆道减压技术、脉络化解剖技术、血管外科技术及胆管空肠吻合技术。通过合理的有次序地使用这四大技术 。

Objective To study the hilar surgical techniques for the resection of extrahepatic cholangiocarcinoma.Methods To analyze the data from 28 cases with extrahepatic cholangiocarcinoma who underwend operation in our hospital from 1995 to 2002.All cases were divided in two groups:without using hilar surgical techniques group(1995-1998) and hilar surgical techniques group(1999-2002).Each group had 14 cases.Results After using properly hilar surgical techniques,the resectional rate of extrahepatic cholangiocarcinoma rasied from 21.5% in the early stage to 64.5% in the late stage.There was no postoperative death on the resection group.Conclusion That the instant decompression of the bilary tract after anatomizing the hilar plate,the dissecting technique of 'skeletonization”,the blood vessel surgical technique and the technique of cholangio jejunal anstomosis are the key of hilar surgical techniques on the resection of extrahepatic cholangiocarcinoma.To apply these techniques to treat the disease of extrahepatic cholangiocarcinoma can obtain higher resection rate.