肝部分切除与肝十二指肠韧带骨髂化治疗肝门部胆管癌

Objective To summarize the surgical experience of partial hepatectomy with skeletonization of the hepatoduodenal ligament in the treatment of hilar cholangiocarcinoma.Methods Between Jan.1999 and Dec,2001,67 consecutive patients with hilar cholangiocarcinoma underwent surgical exploration at the Second Military Medical University,Eastern Hepatobiliary Surgery Hospital.The clinical data of these patients were reviewed.Results Of the 67 patients,65(97%) underwent surgical resection.Fourty-nine patients(73%) received curative resection:22 skeletonization resection(SR) and 27 SR combined with partial hepatectomy.In 16 patients(9%) with curative resection the tumor margin was histologically postive and the resection was therefore considered palliative.The tumors were classified according to Bismuth with SR was type Ⅱ(17cases),various types of partial hepatectomy with SR was type Ⅲ and type IV.Right lobectomy with right caudate lobectomy was indicated in type Ⅲ(6cases),left lobectomy with complete caudate lobectomy in type Ⅲb(15cases),right loobectomy with complete caudate lobectomy(3 cases),left lobectomy with complete caudate lobectomy(9 cases) and quadrate lobectomy(2 cases)in type IV.SR and left lobectomy with complete caudate lobectomy was successfully performed in 2 patients(3%) who had undergone palliative biliary resection and cholangiojejunostomy before.Eight patients(12%) had local resecton of the tumor with Roux-en-Y hepaticojejunostomy reconstruction using intrahepatic stents.Two patients(3%) had palliative biliary drainage.Combined portal vein resection was performed in 13 patients(20%) and hepatic artery resection in 27 patients(40%) .Twenty-four atients(36%) had no postoperative complication,23 patients(34%) had minor complications only ,and the remaining 20 patients(30%) had major complications.Of the 20 patients with major complications,14 recovered,the remaining 6 patients died from hepatorenal failure with other organ failures,from myocardial infarction or from intraabdominal or gastrointestianl bleeding 7,12,14,42,57 or 89 days after surgery.The 30-day operative mortality was 4.5%.The mean survival of the patient with curative resecton was 16 months(range 1-32 months);for those undergong palliative resection mean survival was 7 months(range 1-14months).Conlusion Partial hepatectomy with SR for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality.For curative treatmet of hilar cholangiocarcinoma,caudate lobectomy is always recommended in Bismuth Ⅲ/IV.

Partial hepatectomy with skeletonization of the hepatoduodenal ligament for hilar cholangiocarcinoma

Objective To summarize the surgical experience of partial hepatectomy with skeletonization of the hepatoduodenal ligament in the treatment of hilar cholangiocarcinoma. Methods Between Jan. 1999 and Dec. 2001, 67 consecutive patients with hilar cholangiocarcinoma underwent surgical exploration at the Second Military Medical University, Eastern Hepatobiliary Surgery Hospital. The clinical data of these patients were reviewed. Results Of the 67 patients, 65 (97%) underwent surgical resection. Fourty-nine patients (73%) received curative resection: 22 skeletonization resection (SR) and 27 SR combined with partial hepatectomy. In 6 patients (9%) with curative resection the tumor margin was histologically positive and the resection was therefore considered palliative. The tumors were classified according to Bismuth-Corlett into four types. SR was performed in type I (5 cases) and type II (17 cases), various types of partial hepatectomy with SR was type III and type IV. Right lobectomy with right caudate lobectomy was indicated in type III a (6 cases), left lobectomy with left caudate lobectomy in type III b (15 cases), right lobectomy with complete caudate lobectomy (3 cases), left lobectomy with complete caudate lobectomy (9 cases) and quadrate lobectomy (2 cases) in type IV. SR and left lobectomy with complete caudate lobectomy was successfully performed in 2 patients (3%) who had undergone palliative biliary resection and cholangiojejunostomy before. Eight patients (12%) had local resection of the tumor with Roux-en-Y hepaticojejunostomy reconstruction using intrahepatic stents. Two patients (3%) had palliative biliary drainage. Combined portal vein resection was performed in 13 patients (20%) and hepatic artery resection in 27 patients (40%). Twenty-four patients (36%) had no postoperative complications, 23 patients (34%) had minor complications only, and the remaining 20 patients (30%) had major complications. Of the 20 patients with major complications, 14 recovered, the remaining 6 patients died from hepatorenal failure with other organ failures, from myocardial infarction or from intraabdominal or gastrointestinal bleeding 7, 12, 14, 42, 57 or 89 days after surgery. The 30-day operative mortality was 4.5%. The mean survival of the patients with curative resecton was 16 months (range 1–32 months); for those undergoing palliative resection mean survival was 7 months (range 1–14 months). Conlusion Partial hepatectomy with SR for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality. For curative treatment of hilar cholangiocarcinoma, caudate lobectomy is always recommended in Bismuth III/IV.