摘要
目的 探讨胆囊癌合并肝门胆管侵犯手术治疗需注意的问题。方法 回顾性分析 2 2例手术治疗病人的术前发现和手术情况 ,比较切除与未切除受累胆管组术后生存时间。结果 手术证实全组均有明确胆管侵犯。未切除胆管者病情无实质性改善 ,切除胆管组术后生存时间较长 (P <0 0 1) ,但仍存在“扩大的姑息性切除”的情况 ;胰后淋巴结清扫不彻底是妨碍实现临床根治的最主要原因。结论 对胆囊癌合并肝门胆管侵犯者可根据有无肝门横沟处肝实质浸润、左右肝管是否显像、门静脉主干及左右支有无受累决定是否施行扩大根治切除 ;对适合手术切除的晚期胆囊癌宜将淋巴清扫扩大至第 3站 ,以求达到真正意义上的临床根治。
Objective To discuss hints worthy of notice in the surgical management of gallbladder cancer infiltrating hilar biliary tract.Methods The clinical data of 22 cases undergoing surgery was analyzed retrospectively,and the postoperative survival of the patients with and without resection of the infiltrated bile duct compared.Results Involvement of the biliary tract was verified by surgery in all of the patients.Those without resection of the infiltrated bile duct demonstrated no substantial improvement of the condition,while those having the diseased bile duct resected survived longer after operation(P<0\^01).Anyway,there existed the condition of so called 'extended palliative resection',and the main cause hindering radical resection in this group was unsufficient lymphadenectomy in the region posterior to the pancreas.Conclusion Three factors should be considered in the decision making of extended radical resection for gallbladder cancer infiltrating hilar biliary tract:inclusion of the hepatic parenchyma around the hilum,the extent of tumor invasion to the left and right hepatic duct,and involvment of the portal vein.Lymphadenectomy in the late staged cases suitable for radical resection should include the 3rd station nodes to ensure eradication in the real sense.
出处
《中国实用外科杂志》
CSCD
北大核心
2001年第8期480-482,共3页
Chinese Journal of Practical Surgery
