肝门部胆管癌切除后两种胆肠吻合方式的应用体会

目的分析肝门部胆管癌手术切除后两种胆肠吻合方式适应证。方法根据吻合方式的不同,将我科2005年1月至2008年12月手术切除的32例肝门部胆管癌分为A(传统吻合组)、B(新型吻合组)两组,对其临床资料进行回顾性分析。结果采用传统吻合方式的有14例,采用新型吻合方式者18例,两组术后发生暂时性胆漏的例数分别为6例(42.9%)和2例(11.1%);平均手术时间分别为(222.0±42.5)min和(162.6±24.0)min,两组间差异均具有统计学意义(P0.05)。两组术后平均生存时间为(26.82±10.97)个月和(26.17±8.85)个月(P0.05)。结论对于切除范围较大的肝门部胆管癌病人,采用新型胆肠吻合方式简单有效,可有效减少手术创伤,缩短手术时间、降低胆漏发生率。

The analysis of two different hepaticojejunostomy after the hilar cholangiocaxcinoma resected

Objective To analyze and summarize the surgical technique of two mode of hepatic hilar anastomosis in the treatment for the hilar cholangiocarcinoma. Methods The 32 hilar cholangiocarcinoma cases of our department from Jan. 2005 to Dec. 2008 were divided into two groups according to the anastomosis,group A（ traditional method）and group B（improved method）, and the clinical data were analyzed retrospectively. Results The group A included 14 patients and group A included 18, the temporary bile leakage after the operation were 42. 9% （6/14）and 11.1%（2/18）respemively （P〈0.05） ,and the average operation time was（222.0±42.5）minutes and（ 162.6±24. 0）minutes（P〈0. 05） ,while the average survival time were（26. 82 ＋ 10. 97）months of group A and（26. 17 ± 8.85） months group B（P〉0. 05）. Conclusion For the complicated broken bile duct after liver resected of the hilar cholangiocarcinomapatients, the improved hepaticojejunostomy method was a safe, simple and valid method for the hilar cholangiocarcinoma resection, which could decrease the operation injury, shorten the operation time, reduce the bile leakage rate and achieved better long-term survival.