腹腔镜根治性切除治疗肝门部胆管癌15例分析

Clinical application of laparoscopic radical resection of hilar cholangiocarcinoma:An analysis of 15 cases

目的探讨腹腔镜根治性切除治疗肝门部胆管癌的可行性及安全性。方法回顾性分析2013年5月至2018年5月在川北医学院附属医院行根治性手术治疗并经病理学检查证实的15例肝门部胆管癌病人的临床资料,分析术中及术后情况,并随访观察。结果 15例肝门部胆管癌病人中13例行完全腹腔镜手术,2例病人中转开放手术。手术时间为(404.3±62.8)min,术中出血(502.0±133.8)mL,术后住院时间为(9.6±2.7)d,术后首次排气时间为(3.2±0.8)d。术后淋巴结检出数目为(9.5±2.6)枚,1例发现N2淋巴结转移。术后发生胆漏1例,大量腹腔积液1例,切口脂肪液化1例,均经保守治疗后好转出院。所有病人均获得随访,截至2018年5月,随访时间为6～60个月,死亡4例。结论通过术前充分评估及术中探查制定相应手术策略,并且在严格掌握手术适应证的前提下,由具备丰富腹腔镜手术经验的医生主持操作,腹腔镜技术应用于肝门部胆管癌病人相对安全、可行。

Objective To explore the feasibility and safety in the exploration of laparoscopic radical resection of hilar cholangiocarcinoma.Methods The clinical data of 15 patients who underwent radical surgery and confirmed pathologically as hilar cholangiocarcinoma from May 2013 to May 2018 at the Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively.Results Operations were performed successfully in all patients.Among them,13 patients underwent pure laparoscopic surgery and 2 patients were converted to laparotomy.The operation time was(404.3±62.8)minutes.The intraoperative blood loss was(502.0±133.8)mL.The postoperative hospital stay was(9.6±2.7)days.The postoperative initial exhaust time was(3.2±0.8)days.The number of postoperative lymph nodes was detected(9.5±2.6),and 1 patient found lymph node metastasis at N2 station.Biliary leakage occurred after operation in1 patient.Large amount of ascites was found in 1 patient.Incision fat liquefaction happened in 1 patient.All of them were discharged after conservative treatments.All patients had been followed up for 6 to 60 months postoperatively until May 2018.Four patients died.Conclusion Through fully preoperative evaluation and intraoperative exploration,the corresponding surgical strategy is formulated,and under the premise of strictly surgical indications,it will be relatively safe and feasible to apply laparoscopic technology to patients with hilar cholangiocarcinoma when the operation is performed by a rich-experienced surgeon.