扩大根治术在肝外器官侵犯的胆囊癌中的作用

目的 探讨扩大根治术在肝外器官侵犯的胆囊癌患者中的作用.方法 总结2009年12月至2013年12月我院21例行手术治疗的胆囊癌合并肝外器官侵犯患者,16例行联合侵犯脏器切除的胆囊癌扩大根治术,包括4例联合胰十二指肠切除术,3例联合部分横结肠切除术,5例联合胆总管肝总管切除术、肝总管空肠内引流,1例联合右肝动脉切除术,1例联合门静脉左支切除重建术,2例联合远端胃切除术;5例仅行剖腹探查、姑息性胆囊切除或T管外引流.结果 全组无手术死亡,并发症发生率28.6％ （6/21）,扩大根治术组1、2、3年生存率分别为62.5％、37.5％、12.5％,中位生存期21.5个月,均优于姑息性手术组.16例扩大根治术后病理,15例淋巴结阳性,其中腹主动脉旁淋巴结阳性2例.结论 对于肝外器官侵犯的胆囊癌患者,施行联合侵犯器官切除的扩大根治术,能提高手术切除率和生存率,只要仔细选择病例,扩大根治术可以安全施行.

Effect of extended radical resection of the gallbladder carcinoma with extrahepatic organs involvement

Objective To explore the worth of extended radical resection on the gallbladder carcinoma with extrahepatic organs involvement.Methods From Dec.2009 to Dec.2013,total clinicl data of 21 gallbladder carcinoma with extrahepatic organs involvement were retrospectively analyzed.sixteen cases accepted extended radical resection combined with involved organs resection,including 4 cases of combined pancreatoduodenectomy,3 cases of partial transverse colon resection,5 cases of common and hepatic bile duct resection and hepatic duct jejunum Roux-Y anastomosis,1 case of right hepatic artery resection,1 case of left portal vein resection and restruction and 2 cases of distal gastrectomy; 5 cases underwent laparotomy and palliative cholecystectomy and T-tube drainage.Results The complication incidence of 21 patients was 28.6％.1,2,3-year survival rate of extended radical resection were 62.5％,37.5％ and 12.5％ respectively.The mean survival of extended radical resection was 21.5 months as compared with 4.5 months in palliative group.Postoperative pathology found in 15 cases （93.8％） of positive lymph node,of those 2 cases of paraaortic lymph node involvement.Conclusion For gallbladder carcinoma with extrahepatic organs involvement,extended radical resection combined with involved organs resection can increase the resection rate and survival rate,if selected carefully,it can be performed safely.