肝门胆管癌根治术中用胃十二指肠动脉行肝动脉重建

目的 总结胃十二指肠动脉代替肝动脉重建在肝门部胆管癌根治术中的应用经验.方法 回顾性分析2004-2008年9例肝门部胆管癌根治术中,胃十二指肠动脉代替肝动脉重建临床资料及随访结果.结果 9例行肝门部胆管癌根治术肝动脉切除超过1 cm,利用胃十二指肠动脉代替肝动脉进行重建,其中1例联合门静脉部分楔形切除,自身大隐静脉移植修复,8例行肝内胆管支撑.9例术后全身炎症反应综合征于2～3 d后明显缓解,1例术后3 d出现上消化道出血治愈,无手术死亡和住院死亡.术后2周彩色超声临测显示重建肝动脉通畅.9例随访1～4年,中位生存期为23(6～32)个月.结论 胃十二指肠动脉能较好地代替肝动脉重建,减少术后并发症的发生.

Hepatic artery reconstruction after hilar cholangiocarcinoma resection

Objective To summarize the clinical experience of hepatectomy with hepatic artery resection and reconstruction using gastroduodenal artery during radical resection of hilar cholangiocarcinoma.Methods From Dec.2004 to Dec.2008,nine cases of hilar cholangiocarcinoma with hepatic artery invasion were subjected to radical resection comhined with tumor invaded hepatic artery resection and reconstruction using gastroduodenal artery.The clinical data of these patients were reviewed.Results Nine cases underwent hilar cholangiocarcinoma radical resection with hepatic artery resection,immediate hepatic artery reconstruction using gastroduodenal artery end to end anastomosis while hepatic artery resection exceeding 1 cm.One patient underwent partial resection of the portal vein and repair using autogenous segment of great saphenous vein.Roux-en-Y hepaticojejunostomy was performed in 9 patients with intrahepatic bile duct stents in 8 patients.All patients suffered from postoperative transient SIRS and recovered within 2-3 days after operation.One patient experienced massive bleeding from the upper alimentary tract 3 day after operation and the bleeding was controlled afterwards.The blood flow in the reconstructed hepatic arteries monitored by Doppler was normal two weeks after operation.There was no inhospital mortality.9 patients were followed up for 1-4 years,the median survival time is 23 months (6 months to 32 months).Conclusion Hepatic artery can be reconstructed using gastroduodenal artery during a radical resection of hilar cholangiocarcinoma,and hepatic artery reconstruction decreases the postoperative complications.