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目的探讨联合肝切除术治疗晚期肝门部胆管癌的并发症及远期疗效。方法对北京市通州区潞河医院1998年1月～2009年3月行联合肝切除术的9例晚期肝门部胆管癌患者临床资料进行回顾性分析,观察并发症发生率及远期生存率。结果 4例IIIb型患者行左半肝切除,其中1例加做肝固有动脉部分切除及门静脉肝动脉化;3例IIIa型患者行右半肝切除,其中1例行门静脉部分切除+门静脉主干与门静脉左支吻合术;2例IV型患者1例加行右三叶切除术,1例行左半肝切除及胰十二指肠切除术。无手术死亡病例。并发症总发生率为38%。胆漏2例;应激性溃疡3例;胸腔积液4例;肺部感染4例;切口感染2例;大量腹水2例;急性肾衰1例;肝性脑病1例。以上并发症单独发生或并存。1、2、3、5年生存率为88.9%(8/9)、55.6%(5/9)、33.3%(3/9)、11.1%(1/9)。结论联合肝切除术治疗肝门部胆管癌具有可行性,能明显改善晚期肝门部胆管癌的预后。
Objective To investigate the complications and long-term efficacy of combined hepatectomy in the treatment of advanced hilar cholangiocarcinoma. Methods The clinical data of 9 patients with advanced hilar cholangiocarcinoma who underwent combined hepatectomy from January 1998 to March 2009 in Luhe Hospital of Tongzhou District of Beijing were retrospectively analyzed. The incidence of complications and long-term survival rate . Results Four cases of type IIIb were treated with left hepatectomy. One case received partial resection of hepatic artery and hepatic arterialization of the portal vein. Three cases of type IIIa underwent resection of the right hepatectomy. One case underwent partial portal vein resection plus portal vein trunk Portal vein left anastomosis; 2 cases of type IV patients with right right trilobate resection, a case of left hemihepatectomy and pancreatoduodenectomy. No surgical deaths. The total complication rate was 38%. Bile leakage in 2 cases; stress ulcer in 3 cases; pleural effusion in 4 cases; pulmonary infection in 4 cases; incision infection in 2 cases; massive ascites in 2 cases; acute renal failure in 1 case; hepatic encephalopathy in 1 case. The above complications occur alone or co-exist. The 1-, 2-, 3-, 5-year survival rates were 88.9% (8/9), 55.6% (5/9), 33.3% (3/9) and 11.1% (1/9) respectively. Conclusions Combined hepatectomy for hilar cholangiocarcinoma is feasible and can significantly improve the prognosis of advanced hilar cholangiocarcinoma.