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腹腔镜下根治性切除术治疗Ⅳ型肝门部胆管癌的效果分析
Clinical effect of laparoscopic radical resection in treatment of type IV hilar cholangiocarcinoma
文章发布日期:2019年03月08日  来源:  作者:徐 建,张 薇,邬长康,等  点击次数:91次  下载次数:27次

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【摘要】:目的探讨Ⅳ型肝门部胆管癌(pCCA)行腹腔镜下根治性切除术的可行性及安全性。方法回顾性分析川北医学院附属医院2015年7月-2018年9月收治的4例行腹腔镜根治性切除术并经术后病理证实为肝门部胆管癌(Ⅳ型)患者的临床资料,其中男2例,女2例,年龄53~65岁,平均年龄59.4岁。所有患者术前均存在不同程度黄疸,术前给予保肝、退黄、营养支持等对症治疗,2例患者术前行经皮肝穿刺胆道引流术减黄。结果4例患者均顺利完成腹腔镜下根治性切除术,其中3例行左半肝切除+全尾叶切除术+淋巴结清扫+胆肠吻合术;1例患者行扩大右半肝切除+全尾叶切除术+淋巴结清扫+胆肠吻合术。手术时间5.5~8.5 h,术中出血量200~750 ml,其中1例患者术中输血400 ml。术后1例患者出现胆漏,经保守持续引流后好转出院,1例患者术后发生大量腹水,给予护肝、利尿等对症治疗后出院,余患者未发生围手术期并发症。术后随访3~24 个月,1例患者术后11个月发生肝内转移,行介入治疗后目前带瘤生存4个月。结论在术前充分评估、严格掌握手术适应证、熟练的腹腔镜技术以及规范化操作的基础上,Ⅳ型pCCA行腹腔镜下根治性切除术是可行、安全的。术中达到R0切除是影响患者预后的重要因素。
【Abstract】:ObjectiveTo investigate the feasibility and safety of laparoscopic radical resection in the treatment of type IV hilar cholangiocarcinoma. MethodsA retrospective analysis was performed for the clinical data of 4 patients who were admitted to the Affiliated Hospital of Chuanbei Medical College from July 2015 to September 2018, underwent laparoscopic radical resection, and were diagnosed with type IV hilar cholangiocarcinoma based on postoperative pathology. There were 2 female and 2 male patients aged 53-65 years, with a mean age of 59.4 years. All patients had varying degrees of jaundice before surgery and were given symptomatic treatment including liver-protecting treatment, jaundice clearance, and nutritional support. Two patients underwent percutaneous transhepatic biliary drainage before surgery to alleviate jaundice. ResultsAll 4 patients underwent a successful laparoscopic surgery, among whom 3 underwent left hemihepatectomy+total caudate lobe resection+lymph node dissection+choledochoenterostomy, and 1 underwent extensive right hemihepatectomy+total caudate lobe resection+lymph node dissection+choledochoenterostomy. Time of operation was 5.5-8.5 hours, and intraoperative blood loss ranged from 200 to 750 ml, with 400 ml intraoperative blood transfusion in 1 patient. After surgery, 1 patient had bile leakage and was improved and discharged after conservative continuous drainage; 1 patient had massive ascites and was discharged after liver-protecting and diuretic treatment; no perioperative complication was observed in the other 2 patients. The patients were followed up for 3-24 months after surgery; 1 patient developed intrahepatic metastasis at 11 months after surgery and had survived with tumor for 4 months after interventional therapy. ConclusionWith adequate preoperative assessment, strict control of surgical indications, skilled laparoscopic technique, and standardized operation, laparoscopic radical resection is feasible and safe in the treatment of type IV hilar cholangiocarcinoma. R0 resection is an important prognostic factor.
【关键字】:胆管肿瘤; 腹腔镜; 肝切除术; 治疗结果
【Key words】:bile duct neoplasms; laparoscopes; hepatectomy; treatment outcome
【引证本文】:XU J, ZHANG W, WU CK, et al. Clinical effect of laparoscopic radical resection in treatment of type IV hilar cholangiocarcinoma[J]. J Clin Hepatol, 2019, 35(3): 565-569. (in Chinese)
徐建, 张薇, 邬长康, 等. 腹腔镜下根治性切除术治疗Ⅳ型肝门部胆管癌的效果分析[J]. 临床肝胆病杂志, 2019, 35(3): 565-569.

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