Abstract: Clinical application of T-shaped bile duct resection and end-to-end ductal anastomosis in radical surgery of gallbladder carcinoma        LIU Ming-qi, XIE Zhi-hua, FENG Fei-ling, et al. Department I of Biliary Tract, the Third Affiliated Hospital of Naval Medical University，East Hepatobiliary Surgery Hospital, Shanghai 200438，China
Corresponding author：JIANG Xiao-qing, E-mail:jxq1225@sina.com
LIU Ming-qi and XIE Zhi-hua are the first authors who contributed equally to the article.
Abstract    Objective    To investigate the clinical application of T-shaped bile duct resection and end-to-end ductal anastomosis in radical surgery of gallbladder carcinoma. Methods    A total of 13 patients with gallbladder carcinoma who underwent T-shaped resection and end-to-end ductal anastomosis were collected from East Hepatobiliary Surgery Hospital affiliated to Naval Medical University since 2012.The safety and feasibility of this method were discussed retrospectively by analyzing the operation，postoperative pathology and staging，postoperative complications and follow-up. Results    Among all the 13 patients，there were 5 males and 8 females，ranging from 50 to 83 years old，with an average age of 66 years old and 10 patients with gallstones，1 patient with stones and polyps，and 2 patients without stones or polyps and 4 patients with tumor in the cystic duct of the gallbladder，4 patients in the neck，3 patients in the body，and 2 patients in the fundus and 3 patients with CA19-9 positive.The operations were performed between 2012 and 2021.The mean postoperative hospital stay was 10（6-16）days，the mean intraoperative blood loss was 277（100-600）mL，and there was no biliary fistula.One case was lost to follow-up，and the remaining 12 cases were followed up for 1 month to 8 years.The median survival time was 36 months.Among all the patients，6 patients still survived without cancer，with a survival time ranging from 1 to 96 months，and the median survival time was 28 months.Excluding 1 patient who underwent surgery recently，the survival time of the remaining surviving patients was more than 2 years，with the longest survival time being 8 years.No clear evidence of bile duct recurrence and stenosis was observed in postoperative follow-up，and no tumor recurrence and metastasis was observed in all survival patients to the follow-up endpoint. Conclusion    On the premise that bile duct resection margin is negative and R0 resection is undertaken，T-shaped bile duct resection and end-to-end ductal anastomosis can be performed as an option for radical surgery of gallbladder carcinoma in some cases.

Key words: gallbladder carcinoma, T-shaped bile duct resection, end-to-end ductal anastomosis 

摘要： 目的    探讨胆管T型切除端端吻合在胆囊癌根治术中的应用。方法    回顾性分析海军军医大学附属东方肝胆外科医院2012—2021年以来收治的胆囊癌行胆管T型切除端端吻合的13例病人资料，通过分析病人手术方式、术后病理及分期、术后并发症及复查随访情况探讨此种手术方式的安全性及可行性。结果    13例病人中男性5例，女性8例，年龄范围50~83岁，平均年龄66岁，合并胆囊结石10例，结石合并息肉1列，2例无结石或息肉，肿瘤位于胆囊管4例，胆囊颈部4例，胆囊体部3例，胆囊底部2例，CA19-9升高3例。术中平均出血量为277（100~600）mL，术后平均住院时间10（6~16）d，均未出现胆瘘。其中1例失访，其余12例随访时间为1个月至8年，生存时间为1~96个月，中位生存时间36个月，目前生存病人为6例，生存时间为1~96个月，中位生存时间28个月，除去1例近期手术者，术后生存时间均在2年以上，最长8年。术后随访未见明确胆管复发狭窄证据，所有生存病人至随访终点未见肿瘤复发转移。结论    保证胆管切缘阴性，R0切除的前提下，对于部分病人可把胆管T型切除端端吻合作为胆囊癌根治的一种选择。

关键词: 胆囊癌, T型切除, 端端吻合