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目的 探讨胆囊癌合并肝门胆管侵犯手术治疗需注意的问题。方法 回顾性分析 2 2例手术治疗病人的术前发现和手术情况 ,比较切除与未切除受累胆管组术后生存时间。结果 手术证实全组均有明确胆管侵犯。未切除胆管者病情无实质性改善 ,切除胆管组术后生存时间较长 (P <0 0 1) ,但仍存在“扩大的姑息性切除”的情况 ;胰后淋巴结清扫不彻底是妨碍实现临床根治的最主要原因。结论 对胆囊癌合并肝门胆管侵犯者可根据有无肝门横沟处肝实质浸润、左右肝管是否显像、门静脉主干及左右支有无受累决定是否施行扩大根治切除 ;对适合手术切除的晚期胆囊癌宜将淋巴清扫扩大至第 3站 ,以求达到真正意义上的临床根治。
Objective To investigate the issues that need attention in gallbladder carcinoma with hepatic hilar bile duct invasion. Methods We retrospectively analyzed the preoperative findings and operation of 22 patients treated with surgery. We compared the survival time of resection and unresected bile ducts. Results Surgical confirmed that all groups had clear bile duct invasion. There was no substantial improvement in the condition of unresected bile ducts. The survival time was longer in the bile duct resection group (P < 0.01), but there was still an “expanded palliative resection” situation. Insufficient pancreatic lymph node dissection was an obstacle to clinical practice. The most important reason for radical cure. Conclusions The gallbladder carcinoma with hilar bile duct invasion may be based on the presence or absence of hepatic parenchymal infiltrates in the lateral sulcus of the hepatic hilum, left and right hepatic ducts, whether the left and right branches of the portal vein are involved or not. Whether to perform an extended radical resection is appropriate; Late gallbladder cancer should be expanded to the third station lymphatic dissection, in order to achieve a true clinical cure.