CAJ | 학술논문

目的探讨半肝联合肝动脉切除治疗BismuthⅢ、Ⅳ型肝门胆管癌的效果和安全性.方法回顾性分析2003年5月至2012年6月半肝联合肝动脉切除的43例患者的资料,其中右半肝切除12例,左半肝切除28例,左三叶切除3例,联合尾状叶全部或部分切除19例,本组全部患者切除了肝固有动脉,联合门静脉部分切除重建5例,其中2例行肝动脉重建.年龄超过70岁且胆红素＞ 300 μmol/L的5例患者术前行选择性引流减黄,时间2～3周.结果本组患者根治切除率58.1％ (25/43).病理类型:高分化腺癌5例,中分化腺癌13例,低分化腺癌18例,乳头状癌2例,黏液腺癌4例,硬化性腺癌1例,术后并发症发生率为39.5％(17/43),其中胆源性肝脓肿3例,胆瘘4例,肝功能不全合并大量腹水4例,门静脉重建后狭窄2例,肝动脉重建后闭塞1例,胃瘫3例,无手术死亡病例,1、3、5年存活率分别为93.0％ (40/43)、39.5％(17/43)、27.9％(12/43).结论肝门肝管癌侵及肝动脉时,受侵犯的血管多数已经狭窄甚至闭塞,因此,肝动脉切除是安全可行的,如果行门静脉切除重建时,肝动脉亦应同时重建.
목적 탐토반간연합간동맥절제치료BismuthⅢ、Ⅳ형간문담관암적효과화안전성.방법 회고성분석2003년5월지2012년6월반간연합간동맥절제적43례환자적자료,기중우반간절제12례,좌반간절제28례,좌삼협절제3례,연합미상협전부혹부분절제19례,본조전부환자절제료간고유동맥,연합문정맥부분절제중건5례,기중2례행간동맥중건.년령초과70세차담홍소＞ 300 μmol/L적5례환자술전행선택성인류감황,시간2～3주.결과 본조환자근치절제솔58.1％ (25/43).병리류형:고분화선암5례,중분화선암13례,저분화선암18례,유두상암2례,점액선암4례,경화성선암1례,술후병발증발생솔위39.5％(17/43),기중담원성간농종3례,담루4례,간공능불전합병대량복수4례,문정맥중건후협착2례,간동맥중건후폐새1례,위탄3례,무수술사망병례,1、3、5년존활솔분별위93.0％ (40/43)、39.5％(17/43)、27.9％(12/43).결론 간문간관암침급간동맥시,수침범적혈관다수이경협착심지폐새,인차,간동맥절제시안전가행적,여과행문정맥절제중건시,간동맥역응동시중건.
Objective To explore the effect and safety of combination of hemihepatectomy and hepatic artery resection for Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma.Methods A retrospective analysis was made on 43 cases operated from May 2003 to June 2012,including right hemihepatectomy in 12 cases,lefi liver resection in 28 cases,left trisegmentectomy in 3 cases,combined caudate lobe resection in 19 cases,all were with proper hepatic arterectomy,in those cases portal vein resection and reconstruction was carried out in 5 cases,hepatic artery reconstruction in 2 cases.Preoperative PTCD was performed in 5 cases in whom age ＞ 70 and bilirubin ＞ 300 μmol/L.Results Radical resection rate was 58.1％(25/43),5 cases were well-differentiated adenocarcinoma,13 cases of moderately differentiated adenocarcinoma,poorly differentiated adenocarcinoma in 18 cases,papillary carcinoma in 2 cases,mucous adenocarcinoma in 4 cases,sclerosing adenocarcinoma in 1 case,the incidence of postoperative complications was 39.5％ (17/43) including hepatic abscess (3 cases),biliary fistula (4 cases),hepatic insufficiency and massive ascites in 4 cases,portal vein stenosis after reconstruction in 2 cases,hepatic artery obliteration after reconstruction in 1 case,gastric paralysis in 3 cases.There was no inhospital death.1,3,5 year survival rates were 93.0％ (40/43),39.5％ (17/43),and27.9％ (12/43).Conclusions In Bismuth Ⅲ,Ⅳ hilar cholangiocarcinoma,in whom hepatic artery obliteration is common,hepatic arterectomy is safe and feasible,however,concurrent hepatic artery reconstruction is mandatory in those with the reconstruction of the portal vein.