肝门部胆管癌根治性切除术中血管切除和重建15例报告

目的探讨侵犯肝动脉和(或)门静脉的肝门部胆管癌在行根治性切除时肝动脉、门静脉切除重建的方法及安全性。方法回顾性分析2005年1月至2009年12月15例行肝门部胆管癌联合半肝或肝三叶根治性切除同时行肝动脉和(或)门静脉切除重建的临床资料。结果本组行肝动脉切除重建7例。其中,肝右动脉与肝右动脉对端吻合4例,肝固有动脉与肝右动脉吻合1例,肝左动脉与肝右后动脉吻合1例,胃十二指肠动脉与肝右动脉吻合1例。门静脉切除重建8例。其中,门静脉主干与门静脉左支吻合5例,门静脉主干与门静脉右支吻合2例,颈内静脉架桥1例。其中联合肝动脉和门静脉切除重建1例。本组R0切除12例,R1切除3例。术后发生腹腔出血1例,胆漏1例,腹腔感染1例,均经保守治疗痊愈。无围手术期手术死亡病例。结论对侵犯肝动脉和(或)门静脉的肝门部胆管癌联合受累血管切除重建能提高肿瘤的根治切除率。严格的术前评估流程,精细的术中操作和完善的术后管理能保证手术的安全性。

Combined vascular resection and reconstruction in radical resection of hilar cholangiocarcinoma:Report of 15 cases

Objective To evaluate the method and safety of vascular resection and reconstruc tion in radical resection of hilar cholangiocarcinoma. Methods A retrospective analysis on the clinical data of 15 patients with hilar cholangiocarcinoma in the Department of hepatobiliary Surgery from January 2005 to December 21）（19 was conducted. All patients received major hepatectomy combined hepatic artery and（or）portal vein resection followed by reconstruction. Results Seven cases received hepatic artery resection and reconstruction, 8 cases received portal vein resection and reconstruction. One case received both hepatic artery and portal vein resection and reconstruction. Twelve of 15 patients got a R0 radical resection. Postoperative complications occurred in 3 patients,and there was no perioperative death. Conclusion Major hepatectomy combined vascular resection and reconstruction of hilar cholan giocarcinoma can get a high radical resection rate and the operation is safety.