摘要
本文旨在探讨扩大根治术治疗27例进展期胆囊癌的价值。方法:本组男9例,女18例,年龄30～85岁,均经病理确诊为胆囊癌,其中18例有黄疸。12例行HPD(肝部分加胰头、十二指肠切除);10例行胆囊加肝部分和/或肝门部胆管切除,9例重建胆肠内引流,1例外引流;5例行胆囊加肝部分切除,其中1例合并横结肠切除。此外,16例同时作肝十二指肠韧带淋巴结清扫(骨骼化)。结果:12例行HPD者,2例死于多器官功能衰竭和应激性溃疡,1例术后7个月失访,3例分别于术后5、15、15月死于癌复发或转移,6例存活者分别生存2、4、5、9、9、31个月,中位生存期11.4月。行其他术式的15例,4例于术后6、9、15、19月死于癌复发或转移,5例存活者分别存活8、9、12、15和34个月,另6例分别于术后1、1、1、5、12、21个月后失访,中位生存期17.7月。16例骨骼化者,13例有阳性淋巴结。结论:包括肝外胆管切除重建和HPD的扩大根治术可提高进展期胆囊癌的清扫彻底程度,可望改善其预后。
To investigate whether extended radical surgery could improve the prognosis of ad-vanced gallbladder carcinoma. Methods: 27 cases pathologically diagnosed of gallbladder carcinoma were treated by extended radical surgery. The series included 9 9 male and 18 female, from 30 to 85 years old. Twelve cases underwent HPD(hepatopancreatoduodenectomy), 10 cases were subjected to partial hepatectomy and/or hilar bile duct, and the other 5 cases underwent partial liver resection in-cluding 1 patient combined with transverse colectomy. Results: Of the 12 HPD patients, 6 cases sur-vived 2,4,5,8, 9 and 31 months respectively; 2 died of MOF and stress ulcer 1-2 weeks after operation died of tumor metastasis or recurrence 5,15 and 15 months later, and 1 case was lost to follow-up months after operation, of the other 15 patients, 5 cases were survived 9,9,12,15 and 34 months respec-tively; 4 died of tumor recurrence 6,9,15,19 months later; and 6 were lost to follow-up 1,1,1,5,12 and 21 months after operation. Positive lymph nodes existed in 13 of 16 cases whose portal triad was skeleto-nized in the hepato-duodenal ligament. The mean survival time of 10 patients following HPD and the other 15 patients were 11.4 and 17.7 months resspectively. Conclusions: Extended radical surgery may help to prolong the time of survival in advanced gallbladder carcinoma.
出处
《外科理论与实践》
1999年第1期39-42,共4页
Journal of Surgery Concepts & Practice
