CAJ | 학술논문

目的探讨肝门胆管癌(HCC)术后胆道并发症的发生原因和防治措施.方法总结我院1998年9月至2013年9月手术治疗的130例肝门胆管癌患者的病例资料.Bismuth分型:Ⅰ型11例,Ⅱ型33例,Ⅲa型36例,Ⅲb型42例,Ⅳ型8例.手术方式:采用基本术式(胆囊、肝门部胆管和胆总管切除,肝十二指肠韧带“骨骼化”,肝门胆管空肠Roux-en-y吻合)68例,基本术式联合右半肝切除14例、左半肝切除37例、左三叶切除3例、左半肝联合胰十二指肠切除2例,外引流6例.全尾叶或部分尾叶切除39例.联合肝固有动脉切除60例,其中6例重建.门静脉部分切除吻合12例.结果胆道并发症总发生率为26.2％(34/130).其中胆漏21例,经引流后2周内愈合19例,4周后愈合2例.胆道感染7例,应用抗生素和利胆药物后痊愈.吻合口狭窄3例,其中2例再次手术治愈,1例肝内胆管穿刺引流后带管出院.胆汁瘤3例,经介入引流后痊愈.本组因肝功能衰竭死亡2例、多器官功能障碍综合征(MODS)死亡1例,病死率为2.3％(3/130).结论肝门胆管癌术后胆道并发症发生率较高,其中胆漏发生率居众多并发症之首.合理引流是治疗胆漏的最佳方法.
목적 탐토간문담관암(HCC)술후담도병발증적발생원인화방치조시.방법 총결아원1998년9월지2013년9월수술치료적130례간문담관암환자적병례자료.Bismuth분형:Ⅰ형11례,Ⅱ형33례,Ⅲa형36례,Ⅲb형42례,Ⅳ형8례.수술방식:채용기본술식(담낭、간문부담관화담총관절제,간십이지장인대“골격화”,간문담관공장Roux-en-y문합)68례,기본술식연합우반간절제14례、좌반간절제37례、좌삼협절제3례、좌반간연합이십이지장절제2례,외인류6례.전미협혹부분미협절제39례.연합간고유동맥절제60례,기중6례중건.문정맥부분절제문합12례.결과 담도병발증총발생솔위26.2％(34/130).기중담루21례,경인류후2주내유합19례,4주후유합2례.담도감염7례,응용항생소화리담약물후전유.문합구협착3례,기중2례재차수술치유,1례간내담관천자인류후대관출원.담즙류3례,경개입인류후전유.본조인간공능쇠갈사망2례、다기관공능장애종합정(MODS)사망1례,병사솔위2.3％(3/130).결론 간문담관암술후담도병발증발생솔교고,기중담루발생솔거음다병발증지수.합리인류시치료담루적최가방법.
Objective To explore the reasons and preventive measures for biliary complications in post-operation of the hilar cholangiocarcinoma (HCC).Methods From September 1998 to September 2013,we have performed operations for 130 cases of hilar bile duct carcinoma,who were classified into Ⅰ type 11 cases,Ⅱ type 33 cases,Ⅲ type a 36 cases,Ⅲ type b 42 cases,Ⅳ type 8 cases by Bismuth classification.Surgical procedure types included the basic operation type difined as excision with gallbladder,hilar and common bile duct,hepatoduodenal ligament “skeletonized”,and hilar bile duct-jejunum Roux-en-y anastomosis,with or without liver resection.Results The total incidence of biliary complications was 26.2％ (34/130),21 cases of biliary leakage,after drainage of the 19 cases healed in 2 weeks,4 weeks after healing in 2 cases; 7 cases of biliary tract infection,use of antibiotics and cholagogue recovered drug; Stenosis in 3 patients,including 2 cases of reoperation cured,1 case of intrahepatic bile duct after puncture drainage with tube discharge; Gallstone liver abscess (3 cases),after intervention drainage of the whole.This group of 2 cases of death from liver failure,MODS,1 case death.The mortality was 2.3％ (3/130).Conclusions Biliary leakage ranked first in the incidence among biliary complications in post-operation of HCC,and drainage is the best solution for the treatment of biliary leakage.