肝门部胆管癌根治性切除中围肝门区手术处理

目的探讨围肝门区手术处理手段在肝门部胆管癌外科治疗中的临床应用。方法回顾性分析我院2002年1月-2007年12月诊治的86例肝门部胆管癌病人的临床资料。其中，实施单纯内引流术38例，姑息性切除术11例，采取联合尾状叶切除、受侵门静脉肝动脉切除重建、肝内胆管断端整形、肝门区淋巴结清扫等技术完成根治性切除37例。结果肝门部胆管癌的根治性切除率由2002年的33．3％，提高到2007年的75．0％。无围手术期死亡发生。结论联合采用尾状叶切除、肝门部胆管断端整形、受侵门静脉切除重建及肝门区淋巴清扫等围肝门区处理手段可提高肝门部胆管癌根治性切除率，降低手术并发症的发生率。

Surgical management within hepatic hilar region in radical excision of hilar cholangiocarcinoma

Objective To investigate the clinical application of perihilar surgical procedures in the management of hilar cholangiocarcinoma(HCCA).Methods The clinical data of 86 HCCA patients admitted in our hospital from Jan. 2002 to Dec. 2007 were analyzed retrospectively.Simple internal drainage was performed on 38 of the 86 patients and 11 with palliative resection.Radical resection was performed on 37 patients in combination with caudate lobe resection,tumor invasion blood vessels resection,perihilar lymph nodes removal and intrahepatic bile duct plastic maneuver.Results The radical resection rate of HCCA was improved from 33.3% in 2002 to 75.0% in 2007 and there no postoperative mortality in all the 86 patients.Conclusion Combined use of caudate lobe resection,tumor invasion blood vessels resection,perihilar lymph nodes removal and intrahepatic bile duct plastic maneuver could increase radical resection rate of HCCA and effectively alleviate perioperative complications.