中国实用外科杂志

中国实用外科杂志

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肝门胆管癌术中左右胆管成形后分别与空肠吻合11例临床研究

李科浩，邬林泉，殷香保，李恩亮，吴荣寿，邵江华，黄    勇   

  1. 南昌大学第二附属医院肝胆外科，江西南昌330006
  • 出版日期:2015-12-01 发布日期:2015-12-01

  • Online:2015-12-01 Published:2015-12-01

摘要：

目的    探讨左右胆管成形后分别与空肠吻合术在BismuthⅡ型肝门胆管癌手术治疗中的安全性和实用性。方法回顾性分析南昌大学第二附属医院肝胆外科2010年1月至2015年1月收治的11例BismuthⅡ型肝门胆管癌病例的临床资料和随访情况，均行胆管癌根治性切除及左右胆管成形后分别与空肠端侧吻合。结果    手术时间平均5 h，术中出血平均400 mL，术后3～6 d进食，住院时间11～20 d，无住院死亡病例，术后发生胆漏3例，腹腔感染2例，胸腔积液3例，经抗感染及穿刺引流治疗后症状缓解，未出现吻合口出血病例。随访时间3～60个月，有10例病人经过门诊复查和信访获得随访。复查方法为T管造影、CT、MRI检查。1例出现吻合口狭窄，考虑胆管癌复发，1例偶发胆道感染症状，抗生素治疗后情况改善，10例病人中位生存期29个月。结论    BismuthⅡ型肝门部胆管癌切除肿瘤后，左右侧创面胆管残端数目较多且距离较远，可行左右胆管单独整形之后分别与空肠行端侧吻合术。

关键词: 肝门胆管癌, 胆道重建, 根治性切除, 左右胆管分开整形

Abstract:

Left and right sides plastic duct and choledochojejunostomy of hilar cholangiocarcinoma: A study of 11 cases             LI Ke-hao，WU Lin-quan，YIN Xiang-bao，et al. Department of Hepatobiliary Surgery，the Second Affiliated Hospital of Nanchang University，Nanchang 330006, China
Corresponding author：WU Lin-quan，E-mail：Wulqnc@163.com
Abstract    Objective    To investigate safety and practicality of left and right sides dults anaplasty respectively with duct jejunum anastomosis after radical resection of Bismuth Ⅱ hilar cholangiocarcinoma. Methods    The clinical data and follow-up of 11 cases of Bismuth II hilar cholangiocarcinoma under double bile ducts jejunum anastomosis admitted between January 2010 and January 2015 in Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Nanchang University were analyzed retrospectively. Results    The average operation time was about 5 hours; the intraoperative bleeding was 400 mL averagely; all the cases began to eat in postoperative 3 to 6 days; the hospitalization days was about 11 to 20 days. There was no hospital death. There were 3 cases of postoperative bile leakage，2 cases of abdominal infection，3 cases of pleural effusion. The symptoms had been alleviated by anti-infection treatment and drainage. There was no case of anastomotic bleeding. The follow-up period was 3 to 60 months. Ten cases were followed up with outpatient services and letters. The total follow-up rate was 90.9%. Review methods were T angiography，CT，MRI examination. There were 1 case of anastomotic stricture considered recurrence of cholangiocarcinoma, 1 case of accidental biliary tract infection symptoms which can be improved by antibiotic therapy. All the 10 cases were with a median survival of 29 months and overall survival rate of 70.0% (7/10). Conclusion Type II hilar cholangiocarcinoma after resection of the tumor with large number and distance of left and right sides bile ducts should plastic alone and concide with jejunum respectively.

Key words: hilar cholangiocarcinoma, biliary reconstruction, radical resection, left and right sides ducts separate plastic