联合肝叶及肝门部血管切除治疗肝门部胆管癌

目的 探讨联合肝叶及肝门部血管切除在肝门部胆管癌根治术中的应用.方法 回顾性分析解放军总医院肝胆外科2008年1月-2011年12月手术治疗的74例肝门部胆管癌患者的临床资料.74例患者均行手术探查,手术根治性切除33例(44.6％),其中26例联合部分肝切除及血管切除重建;行姑息性切除19例(25.7％);行内引流或外引流术22例(29.7％).结果 联合肝叶及肝门部血管切除的根治性切除组的中位生存时间为27个月,姑息性手术组的中位生存时间为14个月,引流手术组中位生存时间为9个月;根治性切除术的1、2、3年生存率分别为79％、64％、49％;姑息性手术组1、2、3年生存率分别为56％、25％、19％;引流手术组1、2、3年生存率分别为23％、15％、0.结论 根治性切除组的生存率较姑息性手术及引流手术组明显提高,合并肝叶、肝门血管切除可提高肝门胆管癌的手术根治率和生存率;联合肝叶切除有利于肝门胆管癌的根治性切除,提高生存率.     

肝门部胆管癌的外科治疗

目的探讨肝门部胆管癌的诊断和外科治疗的效果.方法对46例肝门部胆管癌的临床资料进行回顾性分析.结果本组术前误诊率43.5%(20/46).18例手术切除,总手术切除率39.1%(18/46),其中根治性切除率26.1%(12/46);22例行周围胆管空肠吻合术;6例U管引流术.根治切除、姑息切除、胆管空肠吻合和U管引流组病人的平均生存期分别是(20.32±11.24)月,(18.12±10.43)月,(12.46±8.78)月和(7.32±5.24)月.切除组病人的生存期显著长于姑息性手术组(P<0.01),而且生活质量显著提高.结论临床医生应重视肝门部胆管癌的早期诊断.根治切除术可显著延长患者生存期和改善生存质量.     

2280例肝门胆管癌的荟萃分析

目的 探讨我国肝门部胆管癌(hilar cholangiocarcinoma,HCC)的流行病学、临床特点、诊断方法、Bismuth-Corlette分型、病理类型、治疗方式、并发症及预后,以期指导临床.方法 以肝门胆管癌为检索词,在中国知网、重庆维普、中国学术期刊网全文数据库CNKI进行检索.将所得22篇文献,共2280例HCC的临床资料进行统计学分析.临床资料分析及数据提取分别由两人完成.结果 与姑息性切除组比较,根治性切除组术后1年生存率(84.0％与46.8％,OR=5.71,95％CI 3.99～8.17,P＜0.01)和术后3年生存率(31.5％与13.5％,OR=4.43,95％CI 2.07～9.47,P＜0.01)均较高.与姑息性切除组相比,内外引流组术后1年生存率(27.2％与38.7％,OR=0.47,95％CI0.31～0.72,P＜0.01)较高.经卡方检验,我们同时发现2002年后HCC手术切除率比2002年前有上升(X2 =35.9588,P＜0.01),但根治性切除率却没有明显变化(X2=2.1052,P=0.1468).结论 根治性切除组术后1、3年生存率高于姑息性切除组.内外引流组术后1年生存率高于姑息性切除组.根治性切除术仍是治疗HCC最理想的方法.如果无法达到根治性切除,姑息性引流术是较好的选择.姑息性切除术并不能提高生存率,因而不被提倡.     

BismuthⅢ和Ⅳ型肝门部胆管癌的整块切除

目的提高肝门部胆管癌的根治性切除率和远期生存率。方法对12例BismuthⅢ型和Ⅳ型肝门部胆管癌患者施行包括部分肝脏、受侵门静脉和肝动脉在内的整块切除。结果术后病理证实9例(75%)获根治性切除,3例(25%)为姑息性切除。术后发生胆漏、肝功能不全和肺部感染各1例,无严重并发症和手术死亡。中位随访5年。9例获根治性切除者1年、3年、5年存活率分别为88.8%(n=8)、55.6%(n=5)和44.4%(n=4),最长存活已达9年。获姑息性切除(n=3)和同期仅放置胆道内支架者(n=5),平均中位生存8.2和9.1个月。结论肝门部胆管癌合并左肝叶和受侵门静脉干联合整块切除能显著提高BismuthⅢ型和Ⅳ型肝门部胆管癌的根治性切除率。只有获得根治性切除的患者才有可能长期生存。     

进展期肝门部胆管癌的扩大切除——肝切除合并肝动脉及门静脉切除重建手术的临床应用

目的：探讨肝门部胆管癌病例的外科治疗手段,分析肝脏切除同时进行门静脉或肝动脉重建在进展期病例中的应用。方法：回顾性分析解放军总医院肝胆外科2007年1月-2010年12月手术治疗的104例肝门部胆管癌患者的病例资料。结果：104例患者均行手术探查,手术根治性切除51例（49．O％）,其中合并肝门部血管切除重建13例,姑息性切除25例（24O％）,引流手术28例（26．9％）。根治手术组中位生存期27个月,姑息性切除组中位生存期16个月,引流组中位生存期11个月。根治性手术组1年生存率76％,3年生存率51％,5年生存率38％;姑息性手术组1年生存率61％,3年生存率35％,5年生存率21％;引流手术组1年生存率33％,3年生存率2．1％,5年生存率为0。     

肝门部胆管癌的诊治：附96例报告

目的:探讨肝门部胆管癌的治疗方法和效果。方法:回顾性分析12年余收治的96例肝门部胆管癌的临床资料，其中手术65例（R0 28例，R1 2例，R2 4例，胆道引流术31例），介入引流31例（PTCD 5例，胆道支架置放术26例），切除术后联合治疗33例（放射治疗18例，经肝动脉灌注化疗15例）。结果:术后生存的95例中获得随访88例，随访率为92.6%，平均随访时间26（2~99）个月。(1)根治性切除组、姑息性切除组、手术引流组、介入引流组的平均生存时间分别为25，15.5，11.5，11个月，根治性切除组优于姑息性切除组（t=8.70,P＜0.01），姑息性切除组优于手术引流组（t=4.31,P＜0.01），介入引流组与手术引流组相似（t=1.31，P＞0.05）。(2)R0 切除联合放化疗组平均生存期为27个月，1，3，5年生存率分别为75%，45%，15%；R0未联合放化疗组平均生存期为24个月，1，3，5年生存率为50%，12.5%，0,两组疗效有显著性差异（t=2.37，P＜0.05； χ=3.88，P=0.049）。(3)胆红素≥400 μmol/L的患者其并发症发生率明显高于胆红素＜400 μmol/L者（P＜0.05）。结论:根治性切除是治疗肝门部胆管癌最有效的方法。手术引流和介入引流治疗效果相似，但介入治疗创伤小，恢复快。当总胆红素≥400 μmol/L时，手术前应作减黄处理。手术切除联合放疗、介入化疗，可以提高疗效。     

36例胃癌急性穿孔临床分析

目的探讨姑息性切除术与根治性切除术治疗胃癌急性穿孔的疗效。方法回顾分析接受外科手术治疗的36例胃癌急性穿孔患者的临床资料。根据手术方式,将上述患者分为3组:穿孔修补术组(n=10),姑息性切除术组(n=12),根治性切除术组(n=14)。所有患者在手术后再接受长达1年的随访,记录患者生存情况。结果 3组患者手术并发症发生率相比差异无统计学意义(P>0.05);3组患者的1年生存率不全相等,差别有统计学意义(P<0.05)。根治性切除术组的1年生存率显著高于姑息性切除术组和穿孔修补术组,差别有统计学意义(P<0.05);姑息性切除术组的1年生存率显著高于穿孔修补术组,差别有统计学意义(P<0.05)。结论对符合根治性切除术与姑息性切除术手术指征的胃癌急性穿孔患者,合理选择手术方式,可有效提高该病预后生存率。     

204例肝门部胆管癌的临床分析

目的 探讨肝门部胆管癌的手术疗效及影响其预后的因素.方法 回顾性分析中国医科大学附属第一医院1996年1月至2007年5月收治的204例肝门部胆管癌的临床资料,并进行多因素Cox回归模型预后因素分析.结果 204例按Bismuth-Corlette分型:Ⅰ型18例,Ⅱ型40例,Ⅲa型30例,Ⅲb型53例,Ⅳ型57例.其余6例未分型.术前行彩超、CT检查和MRCP检查与术中Bismuth分型对照,诊断符合率分别为53.7%、76.4%、100%.手术切除肿瘤92例,其中根治性切除(R0)55例,姑息性切除(R1、R2)37例.胆道探查置管引流98例,开腹探查6例,同种异体原位肝移植手术2例.手术切除组和非手术切除组生存率差异有统计学意义(x2=36.4,P<0.01),根治性切除组和姑息性切除组生存率差异有统计学意义(X2=22.9,P<0.05).Cox模型多因素分析表明手术方式、肿瘤细胞分化程度是二个独立的预后因素.结论 肝门部胆管癌的治疗以手术切除为主,只有根治性切除才能达到最佳疗效.     

肝门胆管癌81例治疗分析

目的探讨肝门胆管癌的治疗方法及效果。方法回顾性分析我院2002~2008年期间收治的81例肝门胆管癌患者的临床资料。结果 81例肝门胆管癌患者中男55例,女26例;年龄38~72岁,平均57.5岁。术前依据MRCP结果,按Bismuth-Corlette分型,Ⅰ型5例,Ⅱ型15例,Ⅲa型14例,Ⅲb型14例,Ⅳ型33例,术中探查发现有15例与术前MRCP分型不符(Ⅱ型5例,Ⅲ型8例,Ⅳ型2例)。根治手术22例,姑息手术17例,内引流21例,外引流21例,各手术方式并发症发生率:根治手术为54.5%(12/22),姑息手术为58.8%(10/17),内引流为23.8%(5/21),外引流为66.7%(14/21),内引流者并发症发生率明显低于其余三者(P<0.01),其余三者间差异无统计学意义(P>0.05)。根治手术、姑息手术、内引流及外引流的中位生存期(月)分别是29.5、13.8、10.5、8.3;1、2、3、5年生存率分别是75.0%、60.0%、38.3%、2.6%,72.7%、26.5%、4.2%、0,50.5%、15.8%2.2%、0,30.6%、8.5%、0、0。根治手术生存率高于姑息手术(χ2=14.20,P=0.000 3),姑息手术高于内引流(χ2=4.50,P=0.040 5),内引流高于外引流(χ2=4.45,P=0.040 1)。结论 Bismuth-Corlette分型可指导手术方式选择,但最终的分型和手术方式需要根据术中探查的情况决定,根治性切除是影响肝门胆管癌患者疗效的主要因素,对无法切除的肝门胆管癌以支撑T管加盆式吻合内引流为首选,尽量避免外引流。     

肝门部胆管癌的外科治疗

目的探讨肝门部胆管癌的外科手术治疗的方法及其效果。方法对96例肝门部胆管癌患者外科手术治疗的方法及疗进行回顾性分析。根治性切除术33例,姑息性切除17例,内和外引流46例。结果手术病死率9.4%,各组间差异无统计意义。手术切除率52%,其中根治性切除率34%;根治性切除、姑息性切除、内引流和外引流组术后生存时间为30、17、13、2.9个月。结论根治性切除是肝门部胆管癌有效的治疗手段,对无法行根治性切除者以内引流为首选治疗方法,能提高患者术后生活质量,延长生存期。     

Improvements in survival by aggressive resections of hilar cholangiocarcinoma.

The operative management of hilar cholangiocarcinoma has evolved because of advances in diagnostic imaging that have permitted improved patient selection, and refinements in operative techniques that have lowered operative mortality rates. Over a 4-year period, 48 patients with hilar cholangiocarcinoma were managed. Twenty-seven patients were treated by palliative measures. Preoperative investigation identified 29 patients who were judged fit for operation without proven irresectability by radiologic studies, and 21 of the 29 patients had tumor removal (72%). Twenty-three operative procedures were performed: local excision (n = 12) (two had subsequent hepatic resection), and hepatic resection primarily (n = 9). Eight patients had complications (35%), and one patient died (4.3%). The mean actuarial survival after local excision in 36 months, and after hepatic resection, 32 months. Palliation as assessed by personal interview was excellent for more than 75% of the months of survival. A combination of careful patient selection and complete radiologic assessment will allow an increased proportion of patients to be resected by complex operative procedures with low mortality rate, acceptable morbidity rate, and an increase in survival with an improved quality of life.     

胰腺癌128例手术疗效的临床观察

目的探讨胰腺癌手术治疗的临床疗效及其预后。方法对1996年1月-2004年12月我院收治的128例胰腺癌病人的临床资料进行回顾性研究。按治疗方式分为胰十二指肠切除术组（28例）、姑息手术组（50例）和未手术组（50例）。结果全组根治性手术切除率为35．90％。胰十二指肠切除术组1、3、5年生存率分别为67．86％、14．29％、3．57％,显著高于其它两组（P〈0．01）;胰十二指肠切除术组生存率曲线显著高于其它两组（P〈0．01）;手术组生存质量显著高于未手术组（P〈0．05）。结论对胰腺癌施行根治性胰十二指肠切除术能显著提高治疗效果及改善预后,从而提高远期生存率并明显提高病人的生存质量。对不能行根治性切除的病人应争取行姑息性手术,亦可改善病人的生存质量。     

142例肝门胆管癌的外科治疗及预后分析

目的比较不同治疗方法对肝门胆管癌预后的影响。方法回顾性研究我院1983～2003年收治的142例肝门胆管癌的临床资料。结果142例中手术切除103例，根治性切除(R0)组50例、非根治性切除(R1，R2)组53例。引流39例：切除者中联合不同范围肝切除者36例、未切肝者67例；引流组中开腹引流15例、非开腹组24例。(1)根治性切除组1、2、3和5年生存率分别为90．61％、59．55％、40．23％和24．76％，非根治性切除组1、2、3和5年生存率分别为49．60％、8．77％、4．38％和4．38％；(2)开腹及未开腹引流组1年生存率分别为26．00％和37．31％，无2年生存者。(3)切肝组1、2、3和5年生存率分别为87．43％、51．04％、36．46％和25．52％，非切肝组1、2、3和5年生存率分别为55．82％、22．41％、12．80％和6．40％。结论术前正确评价可切除性、术中选择适宜的手术方式、合理应用肝切除术是提高疗效的关键问题。在开腹手术中，根治性切除(R0)的效果最佳，非根治性切除(R1，R2)的效果要优于单纯旁路手术；对于非手术处理，支架内引流术的效果优于PTCD。     

Intrahepatic cholangiocarcinoma in Hong Kong

We retrospectively analyzed the results of hepatic resection for patients with intrahepatic cholangiocarcinoma managed between December 1966 and January 1998 at the University of Hong Kong Medical Center, Queen Mary Hospital. There were 61 men and 40 women (mean age, 61.8 years). The clinical records of these patients were reviewed. A survival analysis was performed on the group of patients who had undergone hepatic resection. Twenty-one patients were treated conservatively. Non-resective (palliative) operations were performed in 32 patients. The median survivals after conservative management and palliative operation were 2.5 and 3.3 months, respectively. The remaining 48 patients underwent hepatic resection. The overall operative morbidity and mortality rates after hepatic resection were 41.7% and 16.7%, respectively. The median survival after hepatic resection was 16.4 months. The overall 1-, 3-, and 5-year survival rates after hepatic resection were 60.3%, 29.4% and 22.0%, respectively. Lymphatic permeation (P = 0.007) and hilar nodal metastases (P = 0.009) were found to be significantly associated with poor survival after hepatic resection. Hepatic resection is the treatment of choice for intrahepatic cholangiocarcinoma when it is resectable. Received for publication on Dec. 14, 1998; accepted on Dec. 15, 1998     

Hiläres Cholangiokarzinom

The increasingly performed en bloc resection of liver and hilar tumor has contributed to the improvement of long-term survival in patients with hilar cholangiocarcinoma. Based on preoperative definition of operative strategy we tried to avoid any traumatization of the hilar region. Between September 1997 and September 2002, 82 patients with hilar cholangiocarcinoma were treated at our department. Three patients were excluded from any surgery. The resection rate was 75% (59 of 79); 79% (38 of 48) of en bloc resections of the hilar tumor and adjacent liver were formally curative. The hospital mortality was 7%. The 1- and 3-year survival rates of patients after explorative laparotomy, palliative and curative resection was 27 and 7%, 67 and 26%, 89 and 45% ( p<0.001), respectively. The 1- and 3-year survival rates of patients after en bloc resection were 78 and 49%, respectively. In patients with formally curative en bloc resection ( n=38), the 3-year survival rate was 63%; in patients with N0/R0 resection ( n=31) it was 71%. Lymph node involvement proved to be the only independent prognostic marker if patients who underwent hilar and en bloc resection were included in the multivariate analysis. The R situation was the only significant predictor for patients after en bloc resection. These data justify the extended diagnostic work-up and the principal liver resection in hilar cholangiocarcinoma.     

联合血管切除重建技术在肝门部胆管癌根治术中的应用

目的 探讨肝门部胆管癌根治术中联合血管切除重建的安全性和有效性.方法 回顾性分析2014年6月至2019年12月武汉大学中南医院收治的113例确诊为肝门部胆管癌的病人,包括行姑息治疗50例(姑息治疗组),行开腹肝门部胆管癌根治术63例,其中行联合血管切除重建的肝门部胆管癌根治术26例(联合血管切除重建组),行常规肝门部...     

肝门部胆管癌手术治疗:附64例 报告

目的:探讨肝门部胆管癌手术方式。方法 : 回顾性分析15年间我院收治的64例肝门部胆管癌的临床资料，包括临床表现、临床分型、手术方式及治疗效果。其中35例行手术切除，包括根治性切除16例，姑息性切除19例;29例行胆管引流术，包括胆肠内引流术16例，胆管外引流术13例。结果 : 根治性切除组1，2，3年生存率分别是80.0% , 53.3%及26.7% ;姑息切除组1, 2, 3年生存率分别为50.0%, 16.7%, 0%;胆肠内引流组1,2年生存率分别是45.5%和18.2% ;外引流组则为25.0%和0 。结论:手术切除特别是根治性切除治疗是提高肝门部胆管癌疗效和提高远期生存率可选择的方法。     

联合肝叶切除治疗肝门部胆管癌

目的研究联合肝叶切除术治疗肝门部胆管癌的手术方式、并发症及疗效。方法回顾性分析2000年1月至2011年3月67例肝门部胆管癌患者临床资料。联合左半肝切除23例,右半肝切除9例,尾状叶切除3例,右三叶、右前叶切除各4例,姑息性切除15例,内引流术4例,经皮肝穿刺胆道引流外引流术5例。结果死亡1例,手术并发症发生率37．31％（25／67）。联合肝叶切除组术后中位生存时间为31．1个月,高于姑息性切除组（15．8个月）。联合肝叶切除组的1、3、5年存活率为78．5％、48．3％和29％,姑息性切除组的1、3、5年存活率为43．5％、6．8％、0。术后随访率67．16％（45／67）。结论肝门部胆管癌应积极手术切除治疗,对无明显手术禁忌证的患者行包括肿瘤切除的联合肝叶切除的扩大根治术可延长患者存活期;围手术期正确处理是减少术后并发症,提高患者生活质量和延长存活期的关键。     

Role of Hepatectomy in the Treatment of Hilar Bile Duct Carcinoma

Purpose. To clarify the role of hepatic resection in the surgical treatment of hilar bile duct carcinoma.Methods. Between 1980 and 1997, 68 patients underwent surgery for hilar bile duct carcinoma. The patients were divided into a hepatectomy group (n = 40) and a nonhepatectomized group (n = 28) depending on whether they underwent resection of the bile duct confluence in combination with hepatectomy, or alone, respectively. Background data, operative morbidity and mortality, and survival were retrospectively compared between the two groups.Results. There were no significant differences in morbidity and mortality, or in postoperative survival between the two groups (the 5-year survival rates being 20.6% in the hepatectomized group and 7.1% in the nonhepatectomized group; P = 0.0806). However, patients who underwent curative resection had significantly better postoperative survival than those who underwent noncurative resection (P = 0.048). Hepatectomy provided a significantly better cancer-free margin than bile duct resection alone (P = 0.0296).Conclusions. Although a countermeasure must be taken to decrease mortality, the introduction of hepatectomy with bile duct resection would provide a better cancer-free surgical margin than bile duct resection alone for hilar bile duct carcinoma. Curative resection contributed to long-term survival in this series.