摘要
目的探讨肝切除、肝门一空肠吻合治疗BismuthⅣ型肝门部胆管癌。方法9例BismuthⅣ型肝门部胆管癌均行肝切除（Ⅳb段、Ⅴ段及尾状叶部分肝组织切除），胆道的重建采用肝门一空肠吻合，所有胆管分支均不结扎，均汇入肝门胆汁湖。结果9例患者均行肝切除、达到R。根治性切除、肝门一空肠吻合。围手术期无死亡，术后四周血清AST、ALT、TB明显下降。术后出现胆漏1例、胆道少量出血1例、伤口感染1例，4例均经保守治疗后顺利出院。Karnofsky评分平均为86分。平均随访24．9（9～42）个月，1例于术后9个月死于肿瘤肝内转移，1例于术后17个月死于肿瘤腹腔广泛转移，其余7例目前健康生存，术后已平均生存28．3个月。结论肝切除、肝门一空肠吻合可提高肝门部胆管癌手术根治切除率、利于胆道通畅引流，延长患者生存时间。
Objective To investigate clinical result of hepatectomy and porta-enterostomy in the treatment of Bismuth type IV hilar eholangiocarcinoma. Methods Nine patients with Bismuth type IV hilar cholangiocarcinoma underwent accurate hilar resection（ portal parecnchyma resection including about 1 cm of the hilar part of the segments 5 and 4b and caudate lobe beyond the tumor）, and the biliary drainage was reconstructed by Roux-en-Y portal parecnchyma-jejunum loop anastomosis. None of the biliary radicals had to be ligated and all of them were drained into thus constructed ＂biliary pool＂. Results Hilar resection was successfully performed in all cases, and there was no postoperative mortality. Aspartate transaminase and alanine transaminase and serum bilirubin decreased evidently four weeks later. Three patients presented postoperative complications. One patient developed a transient anastomotic leakage, while one patient developed self-limiting hemobilia, wound infection occurred in one patient. All three patients were treated conservatively and recovered. The mean Karnofsky performance score was 86, with which they could carry on normal activity with minor symptoms of disease. Two patient died after 9 months and 17 months of extensive metastasis and intrahepatic metastasis respectively. The remaining seven patients are alive by a mean follow- up of 24.9 months after surgery without any signs of recurrence. Conclusions With accurate hilar resection and portal parecnchyma-to-enterostomy, the patients considerably benefit from the preservation of liver parenehyma and patent biliary drainage and radical resection. So the new technique prolongs the survival time and enhances the quality of life of the patients.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第4期269-272,共4页
Chinese Journal of General Surgery
关键词
胆管肿瘤
胆管肠吻合术
肝
肝切除术
Bile duct neoplasms
Portoenterostomy, hepatic
Hepateetomy
