肝、胰头、十二指肠联合切除并肝移植治疗肝门部胆管癌1例

背景：由于肝门部解剖学的特殊性和复杂性，肝门部胆管癌长期以来都是外科治疗中的难点。目的：评价肝、胰头、十二指肠联合切除并肝移植治疗晚期肝门部胆管癌的安全性和可行性。 方法：对1例Bismuth分型为Ⅳ型且合并肝门部及胰头后淋巴结转移的肝门部胆管癌患者实施肝、胰头、十二指肠联合切除并原位肝移植。肝移植后初期采用激素、他克莫司及吗替麦考酚酯三联免疫抑制治疗，激素用量较常规小并迅速撤除。对早期肝功能及胰腺功能进行连续观察，并对肿瘤标志物CA19-9进行监测。结果与结论：病理报告为中、低分化性肝门部胆管癌侵犯左、右肝管并肝方叶、肝门部及胰头后淋巴结有转移，胰头、十二指肠及切除部分胃未见癌侵犯。肝移植后患者肝功能恢复顺利，胰腺内、外分泌功能保持良好，CA19-9降至正常。术后1个月患者痊愈出院，随访1年，患者仍生存。说明肝、胰头、十二指肠联合切除并肝移植治疗肝门部胆管癌是安全可行的。

Simultaneous pancreaticoduodenectomy and liver transplantation for hilar cholangiocarcinoma in one case

BACKGROUND:Because of the specificity and complexity of hepatic portal, carcinoma of bile duct of the hepatic portal is a difficulty in the surgical treatment. OBJECTIVE:To evaluate the safety and feasibility of simultaneous pancreaticoduodenectomy and liver transplantation for the end-stage hilar cholangiocarcinoma. METHODS:One recipient diagnosed as hilar cholangiocarcinoma (Bismuth type Ⅳ), with lymph node metastasis of hilar region and that posterior to pancreatic head, received pancreaticoduodenectomy combined with liver transplantation. During the initial period of post-operation, steroid, tacrolimus and mycophenolate mofetil were supplied, and the steroid was used with lower dose than normal and quickly retreated. The parameters of liver and pancreatic functions, and CA19-9 were observed postoperatively. RESULTS AND CONCLUSION: Pathology demonstrated a middle or low differentiation of hilar cholangiocarcinoma, and left, right hepatic duct, together with lobus quadratus were invaded. The tumor metastasized to hilar and posterior pancreatic lymphonodes, without involving the head of pancreas, duodenum and stomach. The function of transplanted liver recovered smoothly, and the endocrine and exocrine functions of pancreas were kept well. CA19-9 dropped to the normal levels. The patient recovered and discharged at 1 month after surgery, and still survived after one year follow up. These suggest that simultaneous pancreaticoduodenectomy and liver transplantation as a treatment of hilar cholangiocarcinoma are safe and feasible.