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目的总结肝门上入路在BismuthⅢ~Ⅳ型胆管癌中临床应用的经验体会。方法回顾性分析2000年7月至2005年10月采用肝门上入路手术切除的20例BismuthⅢ~Ⅳ型胆管癌患者。结果切缘阳性2例。术后近期内并发胸腔积液5例,伤口感染2例,膈下感染1例,胆肠吻合口瘘1例,肝功能衰竭1例。1年生存率为70%(P0=14/20=0.70),2年生存率为50%(P1=7/14=0.50),3年生存率为57%(P2=4/7=0.57)。结论(1)肝门上入路是BismuthⅢ~Ⅳ胆管癌的手术入肝路径。(2)肝正中裂路径由于没有主要的胆管或血管通过,出血少,操作简单,暴露清楚。肝Ⅳ段切除可以完成部分肝门部胆管肿瘤切除。(3)局部扩大的肝切除方法可以最大限度地保存正常肝组织,减少由于肝功能衰竭所导致的各种并发症;尽可能的做到胆管残端病理检查时的R0切除。
Objective To summarize the experience of clinical application of hilar approach in Bismuth Ⅲ-Ⅳ cholangiocarcinoma. Methods A retrospective analysis of 20 patients with cholangiocarcinoma of Bismuth Ⅲ-Ⅳ type excised by suprahepatic approach from July 2000 to October 2005 was performed. Results positive margins in 2 cases. There were 5 cases of pleural effusion, 2 cases of wound infection, 1 case of subphrenic infection, 1 case of biliary and intestinal anastomotic fistula, and 1 case of liver failure. The 1-year survival rate was 70% (P 2 = 4/7 = 0.57) and the 2-year survival rate was 50% (P 1 = 7/14 = . Conclusions (1) Hepatic suprahepatic approach is the pathological operation of Bismuth Ⅲ-Ⅳ cholangiocarcinoma. (2) Liver median fissure path because there is no main bile duct or blood vessels, less bleeding, simple operation, clear exposure. Segmental hepatectomy can complete partial hilar cholangiocarcinoma resection. (3) The local enlargement of the liver resection method can maximize the preservation of normal liver tissue, reduce complications due to liver failure caused; as far as possible when the bile duct stump R0 resection.