CAJ | 학술논문

目的探讨Ⅲ型肝门部胆管癌的治疗策略及效果.方法回顾性分析解放军总医院2009年1月-12月收治的32例Ⅲ型肝门部胆管癌患者的临床资料,总结其手术情况及预后.结果 32例患者中,27例行手术切除治疗,5例行姑息性减黄治疗;10例联合门静脉受侵部分切除重建,4例联合门静脉及肝动脉切除重建.手术切除率为84.3％,根治性切除率达34.4％.6例术后出现胆瘘,4例出现胆瘘合并腹腔内感染,1例出现肠瘘,2例出现上消化道出血,1例术后出现腹腔出血,均经治疗后痊愈.无围手术期死亡病例.术后并发症发病率为43.7％.R0切除组患者术后1、3、5年生存率分别为81.8％、45.5％、27.3％;R1/R2切除组则分别为66.7％、14.3％、0.结论对于Ⅲ型肝门部胆管癌,行联合半肝和(或)尾状叶,甚至联合肝门部血管切除重建的根治性手术,不会增加患者术后并发症发病率及围手术期病死率,可大大提高手术的根治性切除率及远期生存率.
목적 탐토Ⅲ형간문부담관암적치료책략급효과.방법 회고성분석해방군총의원2009년1월-12월수치적32례Ⅲ형간문부담관암환자적림상자료,총결기수술정황급예후.결과 32례환자중,27례행수술절제치료,5례행고식성감황치료;10례연합문정맥수침부분절제중건,4례연합문정맥급간동맥절제중건.수술절제솔위84.3％,근치성절제솔체34.4％.6례술후출현담루,4례출현담루합병복강내감염,1례출현장루,2례출현상소화도출혈,1례술후출현복강출혈,균경치료후전유.무위수술기사망병례.술후병발증발병솔위43.7％.R0절제조환자술후1、3、5년생존솔분별위81.8％、45.5％、27.3％;R1/R2절제조칙분별위66.7％、14.3％、0.결론 대우Ⅲ형간문부담관암,행연합반간화(혹)미상협,심지연합간문부혈관절제중건적근치성수술,불회증가환자술후병발증발병솔급위수술기병사솔,가대대제고수술적근치성절제솔급원기생존솔.
Objective To investigate the treatment strategies and prognosis of type Ⅲ hilar cholangiocarcinoma.Methods We retrospectively analyze 32 patients' data who was admitted to PLA General Hospital from January,2009 to December,2009.Then we summary and analyze their operation status and prognosis.Results In the 32 cases,27 cases underwent operation,the remaining 5 patients just received palliative treatment because of preoperative diagnosis in liver and distant lymph node metastasis.10 cases underwent portal vein reconstruction,4 cases underwent portal vein combined with hepatic artery reconstruction.The operation rate was 84.3％,and the radical resection rate reached 34.4％.After the operation,some patients occurred different complications,including biliary fistula in 6,biliary fistula complicated with intro-abdominal infection in 4,intestinal fistula in 1,upper gastrointestinal bleeding in 2,abdominal bleeding in 1.But all of them recovered after appropriate treatment.There was no death peri-operation.The rate of postoperative complications was 43.7％.The patients' 1 years,3 years,5 year survival rates were 81.8％,45.5％ and 27.3％ respectively in the group of radical resection; while the group of no radical resection were 66.7％,14.3％ and 0 respectively.Conclusions The radical resect operation combine with hemihepatectomy and caudate lobe resection is safe,even combine with hepatic hilar vascular resection and reconstruction.It will not increase the rate of postoperative complication and mortality,furthermore it can greatly improve the rate of radical resection and long term survival.