论文部分内容阅读
目的:探讨扩大肝切除对Bismuth-CorletteⅢ、Ⅳ型肝门胆管癌的临床疗效。方法:回顾性分析蚌埠医学院第一附属医院2008年1月至2015年5月61例Bismuth-CorletteⅢ、Ⅳ型肝门部胆管癌患者的临床资料。其中扩大肝切除组行半肝及以上肝切除和(或)联合尾状叶切除术22例;局限肝切除组行肝门区不规则肝切除术39例。结果:扩大肝切除组患者相比局限肝切除组手术时间长、术中出血量多。扩大肝切除组患者并发症发生率低于局限肝切除组患者;扩大肝切除组无围手术期死亡患者,局限肝切除组有2例围手术期死亡患者;扩大肝切除组R0切除21例,R0切除率为95.5%(21/22),局限肝切除组R0切除20例,R0切除率为51.3%(20/39),差异具有统计学意义(P<0.05);扩大肝切除组1、3、5年生存率分别是77.27%、36.36%、13.64%;局限肝切除组1、3、5年生存率分别是69.23%、20.51%、1.64%,差异具有统计学意义(P<0.05)。结论:Bismuth-CorletteⅢ、Ⅳ型肝门部胆管癌扩大肝切除可以有效提高患者的R0切除率和生存率,改善患者的预后。
Objective: To investigate the clinical effect of extended hepatectomy on Bismuth-Corlette Ⅲ and Ⅳ hilar cholangiocarcinomas. Methods: The clinical data of 61 patients with Bismuth-Corlette Ⅲ, Ⅳ hilar cholangiocarcinoma from January 2008 to May 2015 in the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed. Among them, 22 cases of hepatic resection and / or combined caudate lobe resection were performed in the group of extended hepatectomy, and 39 cases of hepatic segmental hepatectomy in the limited hepatectomy group. Results: Compared with the limited liver resection group, patients in the extended hepatectomy group had longer operation time and more intraoperative blood loss. The patients with enlarged liver resection group had lower complication rate than those with limited hepatic resection group. There were 2 patients with perioperative death in the limited hepatic resection group in the enlarged liver resection group, 21 cases with enlarged resection group, R0 resection rate was 95.5% (21/22). There were 20 cases with R0 excision in the limited hepatectomy group and 51.3% (20/39) cases with R0 resection. The difference was statistically significant (P <0.05) The 3-year and 5-year survival rates were 77.27%, 36.36% and 13.64% respectively. The 1, 3, 5-year survival rates were 69.23%, 20.51% and 1.64% respectively in the limited hepatectomy group, with statistical significance (P <0.05) . Conclusion: Bismuth-Corlette Ⅲ, Ⅳ enlargement of hepatic hilar cholangiocarcinoma can effectively improve the R0 resection rate and survival rate of patients, and improve the prognosis of patients.