CAJ | 학술논문

目的：探讨肝门部胆管癌患者根治性切除术后并发症的诊断与治疗。方法回顾性分析2011年7月至2014年2月在青岛大学附属医院收治的60例肝门部胆管癌根治性切除术后患者临床资料。其中男46例，女14例；年龄41～80岁，中位年龄65岁。所有患者均签署知情同意书，符合医学伦理学规定。患者均为R0切除，基本术式为胆管癌病灶及胆囊切除+胆肠Roux-en-Y吻合。其中联合左半肝切除7例，右半肝切除1例，肝中叶部分切除2例，尾状叶切除4例。分析患者术后并发症的发生、诊断、治疗情况。结果肝门部胆管癌患者根治性切除术后并发症发生率为30%（18/60），其中腹腔活动性出血2例，胆漏6例，腹腔积液合并感染4例，肺部感染4例，切口感染2例。2例腹腔活动性出血患者予加快输液速度、输血和应用止血药物等保守治疗无效后及时行手术探查止血。6例胆漏和4例腹腔积液合并感染患者在超声、CT引导下或介入穿刺置管引流，予有效的引流、抗感染及营养支持等治疗后治愈。4例肺部感染患者给予翻身、拍背、抗感染、祛痰等对症治疗后治愈。2例切口感染患者给予抗生素、及时更换敷料、补充白蛋白及新鲜血浆等治疗后治愈。结论肝门部胆管癌术后并发症发生率高，腹腔活动性出血发病凶险，应早期诊断、积极治疗，必要时手术止血。胆漏为常见并发症，加强引流和抗感染治疗至关重要。
목적：탐토간문부담관암환자근치성절제술후병발증적진단여치료。방법회고성분석2011년7월지2014년2월재청도대학부속의원수치적60례간문부담관암근치성절제술후환자림상자료。기중남46례，녀14례；년령41～80세，중위년령65세。소유환자균첨서지정동의서，부합의학윤리학규정。환자균위R0절제，기본술식위담관암병조급담낭절제+담장Roux-en-Y문합。기중연합좌반간절제7례，우반간절제1례，간중협부분절제2례，미상협절제4례。분석환자술후병발증적발생、진단、치료정황。결과간문부담관암환자근치성절제술후병발증발생솔위30%（18/60），기중복강활동성출혈2례，담루6례，복강적액합병감염4례，폐부감염4례，절구감염2례。2례복강활동성출혈환자여가쾌수액속도、수혈화응용지혈약물등보수치료무효후급시행수술탐사지혈。6례담루화4례복강적액합병감염환자재초성、CT인도하혹개입천자치관인류，여유효적인류、항감염급영양지지등치료후치유。4례폐부감염환자급여번신、박배、항감염、거담등대증치료후치유。2례절구감염환자급여항생소、급시경환부료、보충백단백급신선혈장등치료후치유。결론간문부담관암술후병발증발생솔고，복강활동성출혈발병흉험，응조기진단、적겁치료，필요시수술지혈。담루위상견병발증，가강인류화항감염치료지관중요。
ObjectiveTo investigate the diagnosis and treatment for postoperative complications after radical resection of hilar cholangiocarcinoma.MethodsClinical data of 60 patients with hilar cholangiocarcinoma undergoing radical resection in the Afifliated Hospital of Qingdao University between July 2011 and February 2014 were retrospectively studied. Among the 60 patients, 46 were males and 14 were females with the age ranging from 41 to 80 years old and the median of 65 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent R0 resection and the main surgery was resection of cholangiocarcinoma and cholecystectomy + Roux-en-Y anastomosis. Seven cases underwent combined left hemihepatectomy, 1 combined right hemihepatectomy, 2 combined partial mesohepatectomy and 4 combined caudate lobectomy. Theincidence of postoperative complications and the diagnosis and treatments were analyzed.ResultsThe incidence of postoperative complications after radical resection for hilar cholangiocarcinoma was 30% (18/60), in which, 2 cases developed active intra-abdominal hemorrhage, 6 bile leakage, 4 ascites complicated with infection, 4 pulmonary infection and 2 incision infection. The 2 cases who developed active intra-abdominal hemorrhage received treatments such as accelerating the infusion speed, blood transfusion and use of hemostatic. Surgical exploration was then performed to stop bleeding when conservative treatments failed. The 6 cases who developed bile leakage and 4 cases who developed ascites complicated with infection underwent percutaneous catheter drainage under the guide of ultrasound or CT or by interventional operation. These patients were cured after effective drainage, anti-infection treatment and nutritional support. The 4 patients who developed pulmonary infection were cured after symptomatic treatments such as body turning over, back slapping, anti-infection treatment and expectorant medication. The 2 patients who developed incision infection were cured after receiving treatments such as antibiotics, changing dressing timely and supplement of albumin and fresh plasma.ConclusionsThe incidence of postoperative complications after radical resection for hilar cholangiocarcinoma is high. Active intra-abdominal hemorrhage is extremely dangerous, which shall be diagnosed early and treated positively, and surgical hemostasis shall be performed when necessary. Bile leakage is the common complication. Strengthening the drainage and anti-infection is very important.