摘要
目的分析肝门部胆管癌患者行根治术中行血管切除重建的临床疗效。方法回顾性分析2018年4月至2025年4月安徽医科大学第一附属医院肝胆胰外科151例行肝门部胆管癌根治术的肝门部胆管癌患者的临床资料。其中男91例,女60例,年龄(65.4±10.5)岁。根据肝门部胆管癌根治术是否联合血管切除分为血管切除组(n=19)和对照组(n=132)。观察两组患者术后并发症如术后出血、术后胆瘘、术后血栓形成,以及术中出血量、R_(0)切除率、围手术期死亡率、术后半年复发率等。结果血管切除组术前减黄、术中出血量分别为6(31.6)、200(200,200)ml,对照组分别为45(34.1)、200(100,200)ml,两组比较,差异均无统计学意义(χ^(2)=0.05,P=0.829;χ^(2)=1.59;P=0.101)。血管切除组联合肝切除、毕氏手术分型Ⅰ~Ⅱ、手术时间分别为18(94.7)、1(5.3)、420(377.5,512.5)min,对照组分别为79(59.8)、38(28.8)、322.5(260,410)min,两组比较,差异均有统计学意义(均P<0.05)。血管切除组R_(0)切除、围手术期死亡率、术后出血、术后胆瘘、术后血栓、术后病理(腺癌)、术后6个月复发率分别为16(84.2)、2(10.5)、2(10.5)、3(15.8)、1(5.3)、18(94.7)、1(5.9),对照组分别为103(78.0)、5(3.8)、5(3.8)、25(18.9)、2(1.5)、121(91.7)、6(4.7),两组比较,差异均无统计意义(均P>0.05)。血管切除组术后住院时间、术后1 d及3 d丙氨酸转氨酶、术后肝功能衰竭分别为18(13.5,21.5)d、619(305.4,1634.0)U/L、515.7(109.1,1078.3)U/L、1(5.3),对照组分别为14(11,18)、254.5(139.3,468.3)U/L、116.4(72.8,223.3)U/L、3(2.3),两组比较,差异均有统计学意义(均P<0.05)。结论肝门部胆管癌患者根治术中采用血管切除重建有一定的安全性和有效性。
Objective To analyze the clinical efficacy of vascular resection and reconstruction during radical resection in patients with hilar cholangiocarcinoma.Methods A retrospective analysis was conducted on the clinical data of 151 patients with hilar cholangiocarcinoma who underwent radical resection in the Department of Hepatobiliary and Pancreatic Surgery at the First Affiliated Hospital of Anhui Medical University from April 2018 to April 2025.Among them,there were 91 males and 60 females,with an age of(65.4±10.5)years.According to whether radical resection of hilar cholangiocarcinoma was combined with vascular resection,the patients were divided into the vascular resection group(n=19)and the control group(n=132).Postoperative complications such as bleeding,biliary fistula,and thrombosis were recorded,along with intraoperative blood loss,R_(0) resection rate,perioperative mortality,and recurrence rate at six months postoperatively.Results The preoperative bilirubin reduction and intraoperative blood loss in the vascular resection group were 6(31.6)and 200(200,200)ml,respectively,while those in the control group were 45(34.1)and 200(100,200)ml,respectively.There were no statistically significant differences between the two groups(all P>0.05).The combined liver resection,Billroth operation type Ⅰ-Ⅱ,and operation time in the vascular resection group were 18(94.7),1(5.3),and 420(377.5,512.5)min,respectively,while those in the control group were 79(59.8),38(28.8),and 322.5(260,410)min,respectively.There were statistically significant differences between the two groups(all P<0.05).The R_(0) resection,perioperative mortality rate,postoperative bleeding,postoperative biliary fistula,postoperative thrombosis,postoperative pathology(adenocarcinoma),and recurrence rate at 6 months after surgery in the vascular resection group were 16(84.2),2(10.5),2(10.5),3(15.8),1(5.3),18(94.7),and 1(5.9),respectively,while those in the control group were 103(78.0),5(3.8),5(3.8),25(18.9),2(1.5),121(91.7),and 6(4.7),respectively.There were no statistically significant differences between the two groups(all P>0.05).The postoperative hospital stay,alanine aminotransferase on the 1st and 3rd day after surgery,and postoperative liver failure in the vascular resection group were 18(13.5,21.5)days,619(305.4,1634.0)U/L,and 1(5.3),respectively,while those in the control group were 14(11,18),254.5(139.3,468.3)U/L,and 3(2.3),respectively.There were statistically significant differences between the two groups(all P<0.05).Conclusion Vascular resection and reconstruction during radical resection of hilar cholangiocarcinoma in patients has certain safety and efficacy.
作者
刘磊
张文俊
王剑
王琪
尹胤
孙杨
卜方钊
徐庆祥
Liu Lei;Zhang Wenjun;Wang Jian;Wang Qi;Yin Yin;Sun Yang;Bu Fangzhao;Xu Qingxiang(Department of Hepatobiliary and Pancreatic Surgery,General Surgery Department,the First Affiliated Hospital of Anhui Medical University,Anhui Province Key Laboratory of Tumor Immune Microenvironment and Immunotherapy,Hefei 230000,China;Department of Hepatobiliary and Pancreatic Surgery,General Surgery Department,Chuzhou Hospital Affiliated to Anhui Medical University,Chuzhou 239000,China)
出处
《中华肝胆外科杂志》
北大核心
2025年第11期827-831,共5页
Chinese Journal of Hepatobiliary Surgery
基金
安徽省卫生健康委科研项目(AHWJ2023BAc20043)
肿瘤免疫微环境研究及治疗安徽省重点实验室开放基金项目(20240003)
吴阶平医学基金会科研专项基金(320.6750.2025-02-07)。
关键词
手术后并发症
预后
肝门部胆管癌
血管重建
Postoperative complications
Prognosis
Hilar cholangiocarcinoma
Vascular reconstruction
