CAJ | 학술논문

目的分析肝门部胆管癌患者的预后及术后并发症的发生率,探讨血管切除及重建在肝门部胆管癌治疗中的价值.方法对117例行手术探查的肝门部胆管癌患者病例资料进行回顾性分77析.结果术后病理检查提示,在切除的血管标本中,有82.6%的门静脉血管外膜和50.O%的肝动脉血管外膜被肿瘤侵犯.无血管切除组吻合口瘘和肝功能衰竭的发生率与肝动脉切除组比较,差异有统计学意义(P＜0.05),而与单纯门静脉切除组比较,差异无统计学意义(P＞0.05).无血管切除组患者的1、3、5年生存率分别为59.0%、34.0%和16.0%,与单纯门静脉切除组和肝动脉切除组比较,差异有统计学意义(P＜0.05);非手术切除组患者的1、3、5年生存率分别为13.O%、0和0,与单纯门静脉切除组比较,差异有统计学意义(P＞0.叭),而与肝动脉切除组比较,差异无统计学意义(P＞0.05).结论联合门静脉切除和肝动脉切除均能提高肝门部胆管癌的根治切除率.门静脉切除及重建,不仅能改善部分患者的预后,也不增加手术风险;而肝动脉切除及重建对患者的预后无明显影响,但增加了手术风险.
목적 분석간문부담관암환자적예후급술후병발증적발생솔,탐토혈관절제급중건재간문부담관암치료중적개치.방법 대117례행수술탐사적간문부담관암환자병례자료진행회고성분77석.결과술후병리검사제시,재절제적혈관표본중,유82.6%적문정맥혈관외막화50.O%적간동맥혈관외막피종류침범.무혈관절제조문합구루화간공능쇠갈적발생솔여간동맥절제조비교,차이유통계학의의(P＜0.05),이여단순문정맥절제조비교,차이무통계학의의(P＞0.05).무혈관절제조환자적1、3、5년생존솔분별위59.0%、34.0%화16.0%,여단순문정맥절제조화간동맥절제조비교,차이유통계학의의(P＜0.05);비수술절제조환자적1、3、5년생존솔분별위13.O%、0화0,여단순문정맥절제조비교,차이유통계학의의(P＞0.팔),이여간동맥절제조비교,차이무통계학의의(P＞0.05).결론 연합문정맥절제화간동맥절제균능제고간문부담관암적근치절제솔.문정맥절제급중건,불부능개선부분환자적예후,야불증가수술풍험;이간동맥절제급중건대환자적예후무명현영향,단증가료수술풍험.
Objective To evaluate the role of vascular resection and reconstruction in the treatment of hilar cholangiocarcinoma.Methods 117 patients with potentially resectable hilar cholangiocarcinoma underwent exploration.Twenty-one patients had exploration or drainage only due to distant metastases,and the other 96 patients received surgical resection.Thirty-one of those had vascular resection and reconstruction,including portal vein resection alone in 21 patients,combined hepatic artery and portal vein resection in 2 and hepatic artery resection alone in 8.Therefore,the patients were divided into four groups:non-surgical resection(21),portal vain resection(21),hepatic artery resection(10)and non-vascular resection(65)and their clinical data were reviewed retrospectively.Results The hepatic artery resection group had significantly higher perioperative morbidity and mortality rate(80.0%and 20.0%)than nonvascular resection group(16.9%and 1.5%),respectively,(P＜0.05),while no significant difference was found between the portal vein resection alone group and the non-vascular resection group(P＞0.05).Of all resected vessel specimens.vascular wall invasion beyond the adventitia was pathologically confirmed in 82.6%of the portal veins and 50.0%of the hepatic arteries.The 1-.3-and 5-year survival rates were 59.0%,34.0%,and 16.0%in the non-vascular resection group,versus 44.O%,23.0%and 11.0%in the portal vein resection alone group(P＜0.05)and 18.0%,0 and 0 in the hepatic artery resection group (P＜0.01),respectively,with a significant difference among the three groups.The 1-,3-and 5-year survival rates in the non-surgical resection group were 13.0%,0 and 0,respectively,which were similar to those in the hepatic artery resection group.Though a significant difference in survival rates existed between the portal vein resection alone group and non-resected group(P＜0.001),no significant difference was found between the hepatic artery resection group and non-resected group(P＞0.05).Conclusion Both portal vein and hepatic artery resection can improve resection rate for hilar cholangiocarcinoma,and portal vein resection may improve the prognosis in selected patients.However,hepatic artery resection carl not improve survival and may even lead to an increase of perioperative morbidity and mortality.