CAJ | 학술논문

目的探讨肝切除、肝门-空肠吻合治疗Bismuth Ⅳ型肝门部胆管癌.方法 9例Bismuth Ⅳ型肝门部胆管癌均行肝切除(Ⅳb段、Ⅴ段及尾状叶部分肝组织切除),胆道的重建采用肝门-空肠吻合,所有胆管分支均不结扎,均汇人肝门胆汁湖.结果 9例患者均行肝切除、达到Rο根治性切除、肝门-空肠吻合.围手术期无死亡,术后四周血清AST、ALT、TB明显下降.术后出现胆漏1例、胆道少量出血1例、伤口感染1例,4例均经保守治疗后顺利出院.Karnofsky评分平均为86分.平均随访24.9(9～42)个月,1例于术后9个月死于肿瘤肝内转移,1例于术后17个月死于肿瘤腹腔广泛转移,其余7例目前健康生存,术后已平均生存28.3个月.结论肝切除、肝门-空肠吻合可提高肝门部胆管癌手术根治切除率、利于胆道通畅引流,延长患者生存时间.
목적 탐토간절제、간문-공장문합치료Bismuth Ⅳ형간문부담관암.방법 9례Bismuth Ⅳ형간문부담관암균행간절제(Ⅳb단、Ⅴ단급미상협부분간조직절제),담도적중건채용간문-공장문합,소유담관분지균불결찰,균회인간문담즙호.결과 9례환자균행간절제、체도Rο근치성절제、간문-공장문합.위수술기무사망,술후사주혈청AST、ALT、TB명현하강.술후출현담루1례、담도소량출혈1례、상구감염1례,4례균경보수치료후순리출원.Karnofsky평분평균위86분.평균수방24.9(9～42)개월,1례우술후9개월사우종류간내전이,1례우술후17개월사우종류복강엄범전이,기여7례목전건강생존,술후이평균생존28.3개월.결론 간절제、간문-공장문합가제고간문부담관암수술근치절제솔、리우담도통창인류,연장환자생존시간.
Objective To investigate clinical result of hepatectomy and porta-enterostomy in the treatment of Bismuth type Ⅳ hilar cholangiocarcinoma.Methods Nine patients with Bismuth type Ⅳ hilar cholangiocarcinoma underwent accurate hilar resection(portal parecnchyma resection including about Ⅰ cm of the hilar part of the segments 5 and 4b and caudate lobe beyond the tumor),and the biliary drainage was reconstructed by Roux-en-Y portal parecnchyma-jejunum lpop anastomosis.None of the biliary radicals had to be ligated and all of them were drained into thus constructed"biliary pool".Results Hilar resection was successfully performed in all cases,and there was no postoperative mortality.Aspartate transaminase and alanine transaminase and serum bilirubin decreased evidently four weeks later.Three patients presented postoperative complications.One patient developed a transient anastomotic leakage,while one patient developed self-limiting hemobilia,wound infection occurred in one patient.All three patients were treated conservatively and recovered.The mean Karnofsky performance score was 86,with which they could carry on normal activity with minor symptoms of disease.Two patient died after 9 months and 17 months of extensive metastasis and intrahepatic metastasis respectively.The remaining seven patients are alive by a mean followup of 24.9 months after surgery without any signs of recurrence.Conclusions With accurate hilar resection and portal parecnchyma-to-enterostomy,the patients considerably benefit from the preservation of liver parenchyma and patent biliary drainage and radical resection.So the Hew technique prolongs the survival time and enhances the quality of life of the patients.