中国普外基础与临床杂志

中国普外基础与临床杂志

1 例 Bismuth Ⅲa 型肝门胆管癌的规范化手术治疗

查看全文

目的 总结 1 例行肝门胆管癌(HC 根治术)+门静脉部分切除重建+肝门胆管成形+胆管空肠 Roux-en-Y 吻合术的 Bismuth Ⅲa 型肝门胆管癌病例的诊治过程,并综述国内外关于 HC 手术治疗的发展现状。 方法 回顾性分析总结 1 例 Bismuth Ⅲa 型 HC 患者的临床资料。患者术前总胆红素为 346.8 μmol/L,经经皮肝胆管穿刺引流术(PTBD)减黄后,行联合切除右半肝及全尾状叶切除+门静脉部分切除重建的 HC 根治术。 结果 该例患者的总手术时间约为 290 min,术中出血量约为 350 mL,术中未输血。术后病理学检查示中分化胆管腺癌,切缘无癌细胞残留,淋巴结无转移(0/14)。术后患者未出现相关并发症,恢复顺利,于术后第 9 天出院。患者已在门诊随访 3 年,随访期间患者一般情况良好,未见复发或转移证据。 结论 术前减黄可提高手术安全性及降低术后并发症发生率,针对 Bismuth Ⅲa 型肝门胆管癌,扩大肝切除术可提高肝门胆管癌患者的 R0 切除率与延长术后生存期。

Objective To summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma undergoing the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad. Methods To retrospectively summary and analysis 1 case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with right hemi-hepatectomy+ total caudate lobectomy+partial portal vein resection and reconstruction after reducing jaundice by ercutaneous transhepatic biliary drainage (PTBD). We retrieved domestic and foreign related literatures. Results Operative time of this patient was 290 min and intraoperative bleeding was 500 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed up in the outpatient department for 3 years, and was generally in good condition. The evidence of recurrence or metastasis wasn’t found. Conclusions Preoperative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extended liver resection for a patient of Bismuth type Ⅲa hilar cholangiocarcinoma can improve R0 resection rate and extend postoperative survival.

关键词: 肝门胆管癌; 手术治疗; 肝切除术; 门静脉切除重建

Key words: hilar cholangiocarcinoma; surgical procedure; hepatectomy; portal vein resection and reconstruction

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Kimbrough CW, Cloyd JM, Pawlik TM. Surgical approaches for the treatment of perihilar cholangiocarcinoma. Expert Rev Anticancer Ther, 2018, 18(7): 673-683.
2. Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford), 2015, 17(8): 691-699.
3. Hu HJ, Mao H, Shrestha A, et al. Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: a single-institution experience in China. World J Gastroenterol, 2016, 22(8): 2601-2610.
4. 隋鑫磊, 汤恢焕, 肖广发, 等. 322 例肝门部胆管癌的临床疗效及预后因素分析. 中华消化外科杂志, 2017, 16(4): 391-397.
5. 中国抗癌协会. 肝门部胆管癌规范化诊治专家共识(2015). 中华肝胆外科杂志, 2015, 21(8): 505-511.
6. Liu F, Ma WJ, Hu HJ, et al. The puzzle and challenge in the treatment of an intraoperative margin-positive proximal bile duct in hilar cholangiocarcinoma. Hepatobiliary Surg Nutr, 2017, 6(6): 411-413.
7. Xiang S, Lau WY, Chen XP. Hilar cholangiocarcinoma: controversies on the extent of surgical resection aiming at cure. Int J Colorectal Dis, 2015, 30(2): 159-171.
8. Ribero D, Amisano M, Lo Tesoriere R, et al. Additional resection of an intraoperative margin-positive proximal bile duct improves survival in patients with hilar cholangiocarcinoma. Ann Surg, 2011, 254(5): 776-781.
9. Liu F, Hu HJ, Regmi P, et al. Hilar cholangiocarcinoma with distal bile duct involvement: is hepatopancreatoduodenectomy always required? Clin Res Hepatol Gastroenterol, 2018, [Epub ahead of print].
10. 胡凯, 游骁翔, 李富宇, 等. 170 例Ⅲ型肝门胆管癌的治疗及预后分析. 中国普外基础与临床杂志, 2014, 21(3): 278-284.
11. 陈孝平, 黄志勇, 陈义发, 等. 肝门部胆管癌根治术肝切除范围的合理选择. 中国普通外科杂志, 2013, 22(1): 8-9.
12. 陈孝平, 项帅. 精准医学时代肝门部胆管癌的治疗. 中华消化外科杂志, 2018, 17(1): 3-8.
13. 陈孝平, 黄志勇, 张志伟, 等. 小范围肝切除治疗 Bismuth-Corlette Ⅲ型肝门部胆管癌. 中华外科杂志, 2009, 47(15): 1148-1150.
14. Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg, 2012, 147(1): 26-34.
15. van Gulik TM, Kloek JJ, Ruys AT, et al. Multidisciplinary management of hilar cholangiocarcinoma (Klatskin tumor): extended resection is associated with improved survival. Eur J Surg Oncol, 2011, 37(1): 65-71.
16. 王晓庆, 房锋, 李广涛, 等. Ⅲ、Ⅳ型肝门胆管癌不同切除方式对预后的影响. 中国肿瘤临床, 2018, 45(5): 237-240.
17. Scurtu RR, Dindelegan G, Bintintan V, et al. Extension of hepatic resection ameliorates survival in patients with type Ⅲa or Ⅲb Klatskin tumors despite surgical complications. Chirurgia (Bucur), 2017, 112(3): 301-307.
18. Ramos E. Principles of surgical resection in hilar cholangiocarcinoma. World J Gastrointest Oncol, 2013, 5(7): 139-146.
19. Kow AW, Wook CD, Song SC, et al. Role of caudate lobectomy in type Ⅲ A and Ⅲ B hilar cholangiocarcinoma: a 15-year experience in a tertiary institution. World J Surg, 2012, 36(5): 1112-1121.
20. Cheng QB, Yi B, Wang JH, et al. Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type Ⅲ and Ⅳ. Eur J Surg Oncol, 2012, 38(12): 1197-1203.
21. Zhimin G, Noor H, ZHENG JB, et al. Advances in diagnosis and treatment of hilar cholangiocarcinoma-a review. Med Sci Monit, 2013, 19: 648-656.
22. Endo I, Matsuyama R, Taniguchi K, et al. Right hepatectomy with resection of caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci, 2012, 19(3): 216-224.
23. Wu XS, Dong P, Gu J, et al. Combined portal vein resection for hilar cholangiocarcinoma: a meta-analysis of comparative studies. J Gastrointest Surg, 2013, 17(6): 1107-1115.
24. Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. HPB (Oxford), 2013, 15(7): 492-503.
25. Molina V, Sampson J, Ferrer J, et al. Surgical treatment of perihilar cholangiocarcinoma: early results of en bloc portal vein resection. Langenbecks Arch Surg, 2017, 402(1): 95-104.
26. Tamoto E, Hirano S, Tsuchikawa T, et al. Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma. HPB (Oxford), 2014, 16(1): 56-61.
27. 董家鸿, 黄志强. 精准肝切除——21 世纪肝脏外科新理念. 中华外科杂志, 2009, 47(21): 1601-1605.
28. Wang HQ, Yang JY, Yan LN. Hemihepatic versus total hepatic inflow occlusion during hepatectomy: a systematic review and meta-analysis. World J Gastroenterol, 2011, 17(26): 3158-3164.
29. 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018): 肝胆手术部分. 中华麻醉学杂志, 2018, (1): ?-?.
30. Rahbari NN, Koch M, Schmidt T, et al. Meta-analysis of the clamp-crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started? Ann Surg Oncol, 2009, 16(3): 630-639.
31. 郭晗, 陈朋, 袁鹏, 等. 术前胆道引流对肝门胆管癌术后病人的影响的 Meta 分析. 肝胆外科杂志, 2017, 25(3): 185-189, 217.
32. 李澄云, 牛秀峰, 倪家连. 术前减黄对肝门部胆管癌手术效果的影响. 肝胆胰外科杂志, 2017, 29(3): 203-206.
33. 牛宏, 李明阳. 不同胆道引流方式治疗肝门部胆管癌所致黄疸的疗效观察. 中华胃肠内镜电子杂志, 2017, 4(3): 103-108.
34. 张辉, 张振, 张海涛, 等. 肝门部胆管癌根治术前经内镜鼻胆管引流和经皮经肝胆管造影引流术的临床效果观察. 腹部外科, 2017, 30(3): 197-201.
35. 国际肝胆胰学会中国分会, 中华医学会外科学分会肝脏外科学组. 胆管癌诊断与治疗——外科专家共识. 临床肝胆病杂志, 2015, 31(1): 12-16.
36. 王健东, 沈军, 周学平, 等. 提高 Bismuth-Corlette Ⅲ型肝门部胆管癌根治性切除率及安全性的综合措施. 中华外科杂志, 2013, 51(7): 596-599.
37. 晏益核, 黄玉斌, 蔡小勇. 肝门部胆管癌的外科治疗现状. 中国普通外科杂志, 2017, 26(2): 246-251.
38. Miyazaki M, Yoshitomi H, Miyakawa S, et al. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. J Hepatobiliary Pancreat Sci, 2015, 22(4): 249-273.
39. Furusawa N, Kobayashi A, Yokoyama T, et al. Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality. World J Surg, 2014, 38(5): 1164-1176.
40. Hosokawa I, Shimizu H, Yoshidome H, et al. Surgical strategy for hilar cholangiocarcinoma of the left-side predominance: current role of left trisectionectomy. Ann Surg, 2014, 259(6): 1178-1185.