CAJ | 학술논문

目的探讨提高Bismuth-CorletteⅢ型肝门部胆管癌根治性切除率及安全性的综合性措施.方法回顾性分析2009年6月至201 1年12月Bismuth-CorletteⅢ型肝门部胆管癌15例患者的临床资料,其中男性11例,女性4例;年龄45 ～74岁,平均59岁.所有病例采取磁共振胰胆管成像(MRCP)、双源螺旋CT结合IQQA-Liver CT影像解读分析系统进行术前评估,治疗方式采取选择性保留侧肝脏胆管引流、切除侧肝脏半肝血流阻断、半肝联合全尾状叶连续性切除+区域淋巴结清扫,分析术前评估肿瘤侵犯胆管、门静脉、肝动脉的方法及治疗方式的选择.结果双源螺旋CT结合IQQA-Liver CT影像解读分析系统进行三维重建可以较清楚地显示肿瘤侵犯胆管、肝动脉、门静脉的情况.半肝联合全尾状叶切除后余肝体积均＞40％,经过选择性术前引流及选择性半肝血流阻断,半肝联合全尾状叶连续性切除术后有一过性肝功能异常加重,无围手术期死亡.结论联合MRCP、双源螺旋CT及IQQA-Liver CT影像解读分析系统可以较准确地术前评估肝门部胆管癌侵犯程度,制定手术方案.半肝联合全尾状叶连续性切除+区域淋巴结清扫可以作为Bismuth-CorletteⅢ型肝门部胆管癌的一种治疗选择.
목적 탐토제고Bismuth-CorletteⅢ형간문부담관암근치성절제솔급안전성적종합성조시.방법 회고성분석2009년6월지201 1년12월Bismuth-CorletteⅢ형간문부담관암15례환자적림상자료,기중남성11례,녀성4례;년령45 ～74세,평균59세.소유병례채취자공진이담관성상(MRCP)、쌍원라선CT결합IQQA-Liver CT영상해독분석계통진행술전평고,치료방식채취선택성보류측간장담관인류、절제측간장반간혈류조단、반간연합전미상협련속성절제+구역림파결청소,분석술전평고종류침범담관、문정맥、간동맥적방법급치료방식적선택.결과 쌍원라선CT결합IQQA-Liver CT영상해독분석계통진행삼유중건가이교청초지현시종류침범담관、간동맥、문정맥적정황.반간연합전미상협절제후여간체적균＞40％,경과선택성술전인류급선택성반간혈류조단,반간연합전미상협련속성절제술후유일과성간공능이상가중,무위수술기사망.결론 연합MRCP、쌍원라선CT급IQQA-Liver CT영상해독분석계통가이교준학지술전평고간문부담관암침범정도,제정수술방안.반간연합전미상협련속성절제+구역림파결청소가이작위Bismuth-CorletteⅢ형간문부담관암적일충치료선택.
Objective To investigate the comprehensive measures for improving radical resection rate and safety of Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma.Methods The clinical data of 15 patients with Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma who performed radical resection from June 2009 to December 2011 was analyzed retrospectively.There were 11 male and 4 female patients,aged from 45 to 74 years (mean 59 years).The preoperative evaluation were conducted by using magnetic resonance cholangiopancreatography (MRCP),dual source spiral CT combined with IQQA-Liver CT Imaging Analysis System providing three-dimensional reconstruction of tumor,bile duct,hepatic artery and portal vein,which could help to chose the appropriate treatment modality.All patients were treated with selective hemi-hepatic vascular control of removal liver,hemi-hepatectomy combined with whole caudate lobe resection and regional lymphadenectomy.The merits of each evaluation methods and measures of surgical treatment were analyzed thoroughly.Results The preoperative evaluation modalities including the dual source spiral CT combined with IQQA-Liver CT Imaging Analysis System could clearly show the involvement of bile duct,hepatic artery and portal vein invaded by the tumor.The satisfactory postoperative recovery could be achieved by the remnant liver volume of ＞ 40％ after the hemi-hepatectomy combined with whole caudate lobe resection through the selective preoperative biliary drainage and hemihepatic vascular control.The mean complication was transient aggravated liver dysfunction.There was no death reported during perioperative period in the group.Conclusions The preoperative imaging evaluation modalities including MRCP,dual source spiral CT combined with IQQA-Liver CT Imaging Analysis System could do favor for the preoperative evaluation of invasion degree of hilar cholangiocarcinoma and the selection of appropriate surgical treatment.Hemi-hepatectomy combined with whole caudate lobe resection and regional lymphadenectomy could be an alternative management of Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma.