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目的:探讨精准外科技术在肝门部胆管癌手术治疗中的应用及治疗效果。方法:回顾性分析2007年5月—2012年12月应用精准外科技术行手术治疗的44例肝门部胆管癌患者的临床资料。结果:44例患者中行R0切除19例(43.2%),R1切除7例,R2切除5例,姑息性手术5例,活检加内/外引流8例;联合肝切除18例,联合肝固有动脉切除重建2例。手术平均用时为(5.8±1.6)h,术中平均出血量为(810±509)mL,术后发生各种并发症28例次,术后1个月内死亡1例(1/44)。39例患者获得随访4-62个月,总体术后1,3,5年生存率分别为67.7%,30.8%,10.6%。R0根治性切除者术后1,3,5年生存率分别为93.3%,43.2%,13.9%。非根治性切除手术术后1,3,5年生存率分别为50.5%,26.8%,0,获R0根治性切除者生存率明显高于非根治性手术患者(χ2=4.61,P<0.05);联合肝叶切除术后1,3,5年生存率分别为94.1%,52.7%,11.8%,未行联合肝叶切除的术后1,3,5年生存率分别为69.2%,25.4%,0,前者生存率明显高于后者(χ2=15.26,P<0.05)。结论:精准外科技术在肝门部胆管癌手术治疗中的应用,可提高其根治性手术切除率,减少术后并发症的发生率,改善治疗效果。
Objective: To investigate the application of precision surgical technique in surgical treatment of hilar cholangiocarcinoma and its therapeutic effect. Methods: The clinical data of 44 patients with hilar cholangiocarcinoma underwent surgical treatment from May 2007 to December 2012 were retrospectively analyzed. Results: Among the 44 patients, R0 resection was performed in 19 cases (43.2%), in R1 resection in 7 cases, in R2 resection in 5 cases, in palliative surgery in 5 cases, biopsy plus internal / external drainage in 8 cases, combined with hepatectomy in 18 cases, Excision and reconstruction in 2 cases. The average operation time was (5.8 ± 1.6) h. The mean amount of bleeding during operation was (810 ± 509) mL. There were 28 cases of complications after operation and 1 case (1/44) died within 1 month after operation. 39 patients were followed up for 4-62 months. The overall 1, 3, 5-year survival rates were 67.7%, 30.8% and 10.6% respectively. The 1, 3, 5-year survival rates of radical resection of R0 were 93.3%, 43.2% and 13.9% respectively. The survival rates at 1, 3, and 5 years after non-radical surgery were 50.5% and 26.8%, respectively. The survival rates of patients undergoing R0 radical resection were significantly higher than those of non-radical surgery patients (χ2 = 4.61, P <0.05) . The 1, 3, 5-year survival rates after combined hepatectomy were 94.1%, 52.7% and 11.8% respectively. The 1,3 and 5-year survival rates after unilateral hepatectomy were 69.2% and 25.4% , 0, the former survival rate was significantly higher than the latter (χ2 = 15.26, P <0.05). Conclusion: The application of precise surgical technique in the surgical treatment of hilar cholangiocarcinoma can improve its radical surgical resection rate, reduce the incidence of postoperative complications and improve the therapeutic effect.