联合肝切除术结合肝动脉重建治疗10例肝门部胆管癌临床分析

目的分析联合肝切除术结合肝动脉重建治疗肝门部胆管癌10例患者的应用效果。方法回顾性分析2016年1月至2017年2月10例均接受联合肝切除术结合肝动脉重建治疗的肝门部胆管癌患者资料,分析手术情况、围术期并发症及随访结果。结果10例患者中实施左半肝联合尾状叶切除4例(Ⅲb型),右半肝联合尾状叶切除3例(Ⅲa型),尾状叶切除2例(Ⅱ型),切除肝门部胆管及部分左内叶、右前叶及尾状叶1例(Ⅳ型);接受肝右动脉切除重建6例,肝固有动脉切除重建4例;R0切除率为80.0%,围术期均无死亡病例,术后胆瘘、消化道出血、肝动脉血栓继发胆道感染各1例(10.0%),均经保守治疗后症状好转;术后随访9~24个月,3例患者分别因肿瘤复发、肝动脉血栓、肝脓肿而死亡,术后24个月的生存率为70.0%(7/10)。结论给予肝门部胆管癌患者联合肝切除术结合肝动脉重建治疗可提高R0切除率,改善肝功能,且患者围术期并发症少、术后生存率高。

Study on hepatectomy combined with hepatic artery reconstruction in treatment of 10 cases of hilar cholangiocarcinoma

ObjectiveTo analyze the application effect of hepatectomy combined with hepatic artery reconstruction in treatment of 10 cases of hilar cholangiocarcinoma (HCCA). MethodsThe clinical data of 10 patients with Hilar Cholangiocarcinoma who underwent hepatectomy combined with hepatic artery reconstruction from January 2016 to February 2017 were analyzed retrospectively. ResultsAmong the 10 patients, 4 cases underwent left hemihepatectomy combined with caudate lobectomy (type ⅢB), 3 casesunderwent right hemihepatectomy combined with caudate lobectomy (type Ⅲa), and 2 casesunderwent caudate lobectomy (type Ⅱ), 1 case underwent right anterior lobe and caudate lobe resection (type Ⅳ); There were 6 cases of right hepatic artery resection and reconstruction, 4 case of proper hepatic artery resection and reconstruction; The R0 resection rate was 80.0%, no death cases during the perioperative period was found, 1 case of postoperative biliary fistula, 1 cases of gastrointestinal bleeding, 1 cases of hepatic artery thrombosis secondary to biliary tract infection were found, all of which improved after conservative treatment; All patients were given postoperative follow-up for 9~24 months, 3 patients died of tumor recurrence, hepatic artery thrombosis and hepatic abscess, and the 24-month survival rate was 70.0% (7/10). ConclusionHepatectomy combined with hepatic artery reconstruction in treatment of HCCA can increase R0 resection rate, improve liver function, which have less perioperative complications and high postoperative survival rate.