区域性肝门阻断在Ⅲ型肝门部胆管癌根治性切除中的应用-附49例报告

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (5): 594-596.

区域性肝门阻断在Ⅲ型肝门部胆管癌根治性切除中的应用-附49例报告

张国伟，　周　杰

南方医科大学南方医院肝胆外科，广州 510515

收稿日期:2010-11-19 出版日期:2011-09-25 发布日期:2011-09-29
通讯作者: 周　杰，教授，博士生导师，E-mail: Jacky@fimmu.com E-mail:guowizhang77＠hotmai1.com
作者简介:张国伟（1977-)，男，河南省焦作市人，博士，主治医师，研究方向：肝胆外科及肝脏移植

Application and experience in radical excision of hilar cholangiocarcinoma by regional blocking of hepatic hilum：a report of 49 cases

ZHANG Guo-wei, ZHOU Jie

Department of Hepato-billiary Surgery, Nanfang Hospital, Southern Medical College, Guangzhou 510515, China

Received:2010-11-19 Online:2011-09-25 Published:2011-09-29

摘要/Abstract

摘要：

目的　探讨区域性肝门阻断在Ⅲ型肝门部胆管癌根治性切除中的应用。方法　回顾性分析2002年-2010年11月收治的49例III型肝门部胆管癌的临床资料，其中治疗组24例解剖第1、2、3肝门后进行区域性阻断后，行根治性切除；对照组25例不解剖第2、3肝门，行常规根治性切除。结果　治疗组无围手术期死亡发生，术后发生胆漏2例，肺部感染2例，均经积极非手术治疗恢复。对照组围手术期死亡2例，肝断面出血1例，胆漏2例，肺部感染2例。术后获得随访40例，随访率为82%，平均生存时间26月(2~65月)。总胆红素≥300μmol/L的患者其并发症发生率明显高于胆红素＜300μmol/L者（P<0.05)。结论当总胆红素≥300 μ mol/L时，手术前应作减黄处理；根治性切除是治疗肝门部胆管癌最有效的方法，区域性肝门阻断可明显降低手术出血量、死亡率及术后并发症的发生率。

关键词: 肝门, 胆管肿瘤, 肝门阻断, 肝切除术

Abstract:

Objective　 To summarize the experience in radical excision of hilar cholangiocarcinoma by regional blocking of hepatic hilum. Methods: The clinical data and long-term outcome of 49 cases of hilar cholangiocarcinoma were analyzed retrospectively, from 2002 to 2009. 24 cases (treatment team) were resected radically after anatomizing and blocking hepatic hilum. 25 cases (contrast team) were resected radically by normal way.　Results　In treatment team, 2 cases of bile leak and 2 cases of pulmonary infection were found and cured by non-operation ways. In contrast team, 2 cases of dead, 1 cases of bleeeding in hepatic cross-section, 2 cases of bile leak, 2 cases of pulmonary infection were found. 40 cases were visited. The average survival time was 26 months (2~65 months). Complications of the cases with high total bilirubin (≥300μmol/L）were higher than the lower (P<0.05）.　Conclusions　The cases with high total bilirubin(≥300 u mol/L）should be treated before operation. The best prognosis can be achieved by radical excision for patient with hepatic hilar cholangiocarcinoma. The methods of regional blocking of hepatic hilum could decrease the volume of hemorrhage, death rate and occurrence of complications after operation.

Key words: Hepatic hilum, , Bile duct neoplasm, Regional blocking of hepatic hilum, Hepatectomy

中图分类号:

R657.4

张国伟, 周杰. 区域性肝门阻断在Ⅲ型肝门部胆管癌根治性切除中的应用-附49例报告[J]. 中国临床解剖学杂志, 2011, 29(5): 594-596.

ZHANG Guo-Wei, ZHOU Jie. Application and experience in radical excision of hilar cholangiocarcinoma by regional blocking of hepatic hilum：a report of 49 cases[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(5): 594-596.

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