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目的探讨侵犯血管的肝门部胆管癌(HCCA)根治术同时联合肝叶及入肝血管切除和重建的临床意义。方法选取徐州医学院附属宿迁医院/南京鼓楼医院集团宿迁市人民医院普外科2006年1月至2014年1月期间收治的62例同时侵犯肝门部肝动脉和门静脉的HCCA患者,根据对患者手术创伤耐受程度的评估、营养状况及家属的意愿,其中33例行HCCA根治术+肝叶切除+肝动脉和门静脉联合切除重建术即R0切除(简称联合切除组),29例仅行姑息性胆管肿瘤切除和(或)内引流减黄手术即R1~2切除(简称姑息手术组)。结果联合切除组和姑息手术组患者的中位生存期分别为26.3个月和9.6个月,1、2、3年生存率分别为84.85%比26.32%、66.67%比15.79%和42.42%比0,联合切除组患者的中位生存时间和1、2、3年生存率长于或高于姑息手术组(t=4.470、P=0.000。χ2值分别为28.338、20.348和15.891,均P=0.000)。联合切除组33例患者中,术后出现并发症9例(27.27%),姑息手术组术后出现并发症5例(17.24%),2组间的差异无统计学意义(χ2=0.888,P=0.346)。联合切除组术后第12天有1例死于肝功能衰竭,围手术期死亡率为3.03%,姑息手术组围手术期无死亡者,围手术期死亡率为0,2组间的差异无统计学意义(χ2=0.893,P=0.345)。结论联合肝叶切除及血管切除重建可明显提高HCCA根治性(R0)切除率,并能提高HCCA患者的1、2、3年生存率。联合血管切除重建和联合肝叶切除的并发症是可控的,不增加围手术期死亡率。
Objective To investigate the clinical significance of radical resection of hilar cholangiocarcinoma (HCCA) combined with hepatic lobe and hepatic resection and reconstruction after vascular invasion. Methods Sixty-two patients with HCCA who underwent hepatic artery and portal vein hysterosoma at the same time were selected from General Surgery Department of Suqian Hospital of Xuzhou Medical College / General Hospital of Suqian People’s Hospital of Nanjing Drum Tower Hospital from January 2006 to January 2014, Traumatic tolerance assessment, nutritional status and the wishes of family members, including 33 cases of HCCA radical surgery + hepatectomy + hepatic artery and portal vein resection and reconstruction that R0 resection (referred to as resection group), 29 cases of palliative Cholangiocarcinoma resection and (or) drainage of yellow surgery that is R1 ~ 2 resection (referred to as palliative surgery group). Results The median survival of patients in the resection group and palliative surgery group was 26.3 months and 9.6 months, respectively. The 1, 2 and 3-year survival rates were 84.85%, 26.32%, 66.67%, 15.79% and 42.42%, respectively , The median survival time and the 1, 2, 3-year survival rates of the patients in the resection group were longer than or higher than those in the palliative surgery group (t = 4.470, P = 0.000.χ2 values were 28.338, 20.348 and 15.891, all P = 0.000) . There were 9 cases (27.27%) of complications in the 33 cases of combined resection group and 5 cases (17.24%) of complications in the palliative surgery group after operation. There was no significant difference between the two groups (χ2 = 0.888, P = 0.346). One patient died of liver failure on the 12th day in the resection group and the perioperative mortality rate was 3.03%. There was no perioperative death in the palliative operation group, and the perioperative mortality rate was 0 and 2, respectively Statistical significance (χ2 = 0.893, P = 0.345). Conclusions Combined hepatic resection and revascularization can significantly improve the radical (R0) resection rate of HCCA and improve the 1, 2, 3-year survival rate of patients with HCCA. Complications of combined revascularization and hepatectomy are manageable without increasing perioperative mortality.