中国实用外科杂志

• 论蓍 • 上一篇    下一篇

腹腔镜半肝联合全尾状叶整块切除治疗肝门胆管癌2例并文献分析

张宇华1洪德飞2张成武1胡智明1金丽明1,吴    嘉1,张远标1   

  1. 1 浙江省人民医院  杭州医学院附属人民医院肝胆胰、微创外科,浙江杭州 310014;2 浙江大学附属邵逸夫医院普外科,浙江杭州 310016
  • 出版日期:2018-11-01 发布日期:2018-11-01

  • Online:2018-11-01 Published:2018-11-01

摘要:

目的    总结分析腹腔镜半肝联合全尾状叶整块切除(en-bloc)治疗肝门胆管癌的治疗经验。方法    回顾性分析 2017年4月和 2017 年9月浙江省人民医院肝胆胰外科行腹腔镜半肝联合全尾状叶 en-bloc 治疗肝门胆管癌的2 例病人临床资料。结果    2例病例Bismuth-Corlette 分型分别为ⅢA 型和Ⅳ型。分别行右半肝联合全尾状叶切除术和左半肝联合全尾状叶切除术。无中转开放手术,无围手术期死亡。手术时间分别为 520 min 和 680 min:出血量为 800 mL 和 500 mL,未行血管重建,行胆肠端侧吻合。2例术中冰冻病理学检查均提示胆管切缘阴性。术后病理学检查结果均为腺癌,上下切缘均阴性,淋巴结阳性(0/12)及(1/9)。术后分别随访 11、 16个月,无复发,无术后胆肠吻合口狭窄。1 例术后发生胆漏,经保守治疗治愈,无术后出血等其他并发症。结论 腹腔镜半肝联合全尾状叶整块切除治疗肝门部胆管癌根治术在有经验的腹腔镜中心选择合适的病人是可以尝试施行的,但须临床数据进一步验证。

关键词: 腹腔镜, 肝门胆管癌, 整块切除, 半肝切除, 全尾状叶切除

Abstract:

Laparoscopic hemihepatectomy with en-bloc total caudate lobectomy in treatment of perihilar cholangiocarcinoma:A report of two cases and review of the literature        ZHANG Yu-hua, HONG De-fei, ZHANG Cheng-wu,et al.*Department of Hepaticobiliarypancreatic and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, China
Corresponding author: ZHANG Cheng-wu,E-mail:zcw1989@sina.com;HONG De-fei,E-mail:hongdefi@163.com
Abstract    Objective    To investigate the role of laparoscopic hemihepatectomy with en-bloc total caudate lobectomy in treatment of perihilar cholangiocarcinoma. Methods    The clinical data of two cases of laparoscopic hemihepatectomy with en-bloc resection of total caudate lobe admitted in Zhejiang Provincial People’s Hospital between April 2017 and September 2017 were analyzed retrospectively. Results    One case was type ⅢA of Bismuth-Corlette and another one is type Ⅳ. One case underwent right hemihepatectomy with en-bloc resection of total caudate lobe and another one underwent left side resection. The operation time was 520 minutes and 680 minutes respectively. The estimated blood loss was 800 mL and 500mL. One patient had bile leakage. The follow-up period was 11 and 16 months, no recurrence or bilioenterostomy stricture was detected. The pathological results: introperative pathological results found all resection margins were clear. Postoperative results showed both cases were adenocarcinomas and lymphoid-node were(0/12) and (1/9). Conclusion    Laparoscopic hemihepatectomy with en-bloc total caudate lobectomy is safe and feasible in experienced center within selected patients,which need further clinical data and verification.

Key words: laparoscopy, perihilar cholangiocarcinoma; en-bloc resection;hemihepatectomy ;total caudate lobectomy