中国普外基础与临床杂志

中国普外基础与临床杂志

完全腹腔镜下肝门部胆管癌根治术 14 例经验总结

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目的 探讨完全腹腔镜下肝门部胆管癌根治术的可行性、安全性及临床疗效。 方法 回顾性收集 2016 年 4 月至 2018 年 6 月期间徐州医科大学附属医院肿瘤外科行全腹腔镜下肝门部胆管癌根治术 14 例患者的临床资料并分析总结,其中 Bismuth Ⅰ型 7 例 Ⅱ型 5 例 Ⅲb 型 2 例。 结果 14 例患者均顺利完成了全腹腔镜下肝门部胆管癌根治手术,手术时间为 190~400 min(中位数为 285 min),术中出血量为 100~500 mL(中位数为 175 mL);无围手术期死亡病例,术后病理学检查均提示胆管腺癌,切缘均为阴性;淋巴结检出数为 6~15 枚/例(中位数为 8 枚/例),3 例患者存在肿瘤周围区域淋巴结转移;术后 2 例患者出现胆汁渗漏,其中 1 例合并腹腔感染,均保守治疗后痊愈出院。术后患者经 3~24 个月(中位随访时间 16 个月)的定期随访,1 例术后 12 个月时肿瘤复发,其余患者至今生存良好。 结论 在有经验的腹腔镜医师操作下,全腹腔镜下肝门部胆管癌根治术是安全可行的,且近期效果较好。

Objective To investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods Retrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ, 5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb. Results Total laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190–400 min (median time of 285 min) and the amount of intraoperative blood loss was 100–500 mL (median amount of 175 mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6–15 per case (median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3–24 months (median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far. Conclusion Under the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.

关键词: 肝门部胆管癌; 全腹腔镜; 根治术

Key words: hilar cholangiocarcinoma; total laparoscopy; radical resection

引用本文: 朱宇潇, 王骥, 马红钦, 刘利, 赵文星. 完全腹腔镜下肝门部胆管癌根治术 14 例经验总结. 中国普外基础与临床杂志, 2019, 26(1): 56-60. doi: 10.7507/1007-9424.201809030 复制

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