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目的总结Ⅲ型肝门部胆管癌的手术经验。方法回顾性分析我院1999年1月至2006年12月,行手术切除的35例Ⅲ型肝门部胆管癌的临床资料。Ⅲa型16例,行肝门部胆管切除8例,行联合右半肝+右侧尾状叶切除7例,行联合右半肝+尾状叶切除、门静脉分叉部切除主干左支吻合1例。Ⅲb型19例,行肝门部胆管切除8例,行联合左半肝+左侧尾状叶切除9例,行联合左半肝+尾状叶切除、门静脉分叉部切除主干右支吻合1例,行联合左半肝+尾状叶切除、门静脉分叉部切除主干右支吻合、肝固有动脉分叉部切除主干右支吻合1例。结果本组32例获得随访,随访时间18～113个月。肝门部胆管切除病例术后病理根治性切除率为37.5%,联合肝叶切除病例术后病理根治性切除率73.7%,3例联合肝叶切除+血管切除病例均获术后病理根治性切除。肝门部胆管切除术后并发症发生率为31.3%,联合肝叶切除组术后并发症发生率为31.6%。3例联合肝叶切除+血管切除病例术后均无胆肠吻合口漏、肝断面坏死、胆漏等严重并发症。结论联合肝叶切除,必要时行受累分叉部血管切除重建,有益于提高Ⅲ型肝门部胆管癌的根治性切除率,且不增加术后并发症的发生率。
Objective To summarize the surgical experience of type Ⅲ hilar cholangiocarcinoma. Methods The clinical data of 35 cases of type Ⅲ hilar cholangiocarcinoma resected in our hospital from January 1999 to December 2006 were analyzed retrospectively. Ⅲa type 16 cases of hilar cholecystectomy in 8 cases, the line of right hepatic + right caudate lobe resection in 7 cases, combined with right hepatic + caudate lobectomy, portal vein bifurcation resection of the left anastomosis of the main branch 1 example. Ⅲ b type 19 cases, hilar cholecystectomy in 8 cases, the line of left hepatic + left caudate lobe resection in 9 cases, the line of left hepatic + caudate lobectomy, portal vein bifurcation resection of the right anastomosis branch 1 Cases, the line of the left hepatic + caudate lobe resection, portal vein bifurcation resection of the right anastomosis of the trunk, hepatic artery bifurcation resection of the right anastomosis in 1 case. Results The group of 32 cases were followed up for 18 to 113 months. Postoperative pathological resection of hilar cholangiocarcinoma was performed in 37.5% of cases, postoperative pathologic resection was performed in 73.7% of the cases combined with hepatectomy, and postoperative pathologic resection was performed in 3 cases of combined lobectomy and vascularization . The incidence of complications after hilar cholangiocarcinoma was 31.3%, and the incidence of postoperative complications in combined hepatic lobectomy group was 31.6%. Three cases of combined hepatectomy + vascular resection cases were no cholecteostomy anastomosis, liver necrosis, bile leakage and other serious complications. Conclusions The combined hepatectomy and, if necessary, the involvement of the affected bifurcation in revascularization can improve the radical resection rate of type Ⅲ hilar cholangiocarcinoma without increasing the incidence of postoperative complications.