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目的探讨高位切除治疗晚期肝门胆管癌的疗效。方法1995～2004年收治的13例晚期肝门胆管癌均施行高位肝管切除。根据肝门胆管癌向肝内外侵犯方向和范围,分为2组。A组8例,肝门胆管癌向肝内外侵犯,其中7例侵犯肝内2、3级肝管;B组5例,2例左肝内大胆管癌侵犯右肝管,3例侵犯右侧2级肝管。A组采用肝门胆管癌骨骼化切除,中央肝切除7例、左肝叶切除1例,3～9支肝管断端重建新的肝门胆管后与空肠行Y形吻合。B组采用切除肝左叶和肝门胆管,右肝管整形后与空肠Y形吻合。结果1例术后死于肝功能衰竭,高位切除肝管的10例中存活10年1例,4年2例,2年2例。结论骨骼化切除、中央肝切除、高位肝管切除和胆肠引流重建能改善晚期肝门胆管癌的疗效。
Objective To investigate the effect of high resection in the treatment of advanced hilar cholangiocarcinoma. Methods 13 cases of advanced hilar cholangiocarcinoma admitted between 1995 and 2004 underwent high hepatic resection. According to the direction and extent of hilar cholangiocarcinoma to liver invasion, divided into two groups. A group of 8 cases of hilar cholangiocarcinoma to the liver and internal and external invasion, of which 7 cases of intrahepatic and hepatic vascular 2,3 grade; 5 cases of group B, 2 cases of left hepatic duct carcinoma of the right hepatic duct involvement, 3 cases of violations of the right Grade 2 hepatic duct. A group of hepatic hilar cholangiocarcinoma bone resection, the central hepatectomy in 7 cases, left hepatic resection in 1 case, 3-9 branches of the liver resection of the new hilar cholangiography and jejunum line Y-anastomosis. In group B, the left hepatic lobe and hilar cholangiocarcinoma were resected and the anastomosis of the right hepatic duct was performed with the jejunum Y-shaped anastomosis. Results One patient died of liver failure after operation, and 10 patients survived for 10 years in 1 case, 2 cases in 4 years and 2 cases in 2 years. Conclusion Skeletal resection, central hepatectomy, high resection of the hepatic duct and reconstruction of biliary drainage can improve the curative effect of advanced hilar cholangiocarcinoma.