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目的:探讨Ⅲ,Ⅳ型肝门部胆管癌的手术治疗方式和效果。方法:回顾性分析2010年4月—2013年2月期间采取手术治疗的16例Ⅲ,Ⅳ型肝门部胆管癌患者的临床资料。结果:16例中行手术切除13例,切除率为81.3%(13/16)。其中行根治性切除术(R0切除)7例,非根治性切除术6例;行左半肝+尾叶切除+右肝管成形、肝管-空肠Roux-en-Y吻合术3例,行右半肝切除+尾叶切除+左肝管成形、肝管-空肠Roux-en-Y吻合术3例,行肝方叶切除及围肝门切除+胆管开口肝门区-空肠盆式吻合术7例;其中2例因总胆红素>400μmmol/L而先行经皮肝穿刺胆管引流(PTCD)后再手术。3例患者无法完成手术切除,其中2例肿瘤侵犯门静脉左右支,1例术中发现肝脏多发转移瘤,3例均行肝内扩张胆管的术中置管引流术。所有患者的术后血清总胆红素水平均明显降低或恢复至正常,术后引流有效率为100%。1例围手术期死亡。结论:对于Ⅲ,Ⅳ型肝门部胆管癌,应力争切除肿瘤,解除胆管梗阻。对肝门区胆管解剖的熟知、娴熟的手术技巧和胆大心细的操作,有望提高手术切除率。
Objective: To investigate the surgical treatment and effect of type Ⅲ and type Ⅳ hilar cholangiocarcinoma. Methods: The clinical data of 16 patients with type Ⅲ and type Ⅳ hilar cholangiocarcinoma who underwent surgery from April 2010 to February 2013 were retrospectively analyzed. Results: Thirteen patients underwent surgical resection in 16 cases, the resection rate was 81.3% (13/16). Among them, radical resection (R0 resection) in 7 cases, non-radical resection in 6 cases; line left hepatic + caudate lobe resection + right hepatic duct formation, Roux-en-Y hepaticojejunostomy in 3 cases, Right hemihepatectomy + caudate lobe resection + left hepatic duct formation, Roux-en-Y hepaticojejunostomy in 3 cases, hepatic resection and hepatic hilus resection + open bile duct portal area - jejunal basin anastomosis 7 cases. Among them, 2 cases underwent percutaneous transhepatic biliary drainage (PTCD) before total bilirubin> 400 μmol / L before surgery. Three patients were unable to complete the surgical resection. Two of the tumors invaded the left and right branches of the portal vein, one was found to have multiple liver metastases in operation, and three patients underwent drainage and drainage during the operation. Postoperative serum total bilirubin levels in all patients were significantly reduced or returned to normal postoperative drainage efficiency was 100%. One patient died perioperatively. Conclusion: For Ⅲ, Ⅳ hilar cholangiocarcinoma, we should strive to remove the tumor and relieve the bile duct obstruction. Hepatobiliary duct anatomy of the well-known, skilled surgical techniques and bold and careful operation, is expected to increase the rate of surgical resection.