论文部分内容阅读
目的 了解肝门部胆管癌 ( Hilar cholangiocarcinoma HC)侵犯周围血管神经的生物学特性和术后经导管肝动脉灌注( TAI)对 HC的辅助疗效。 方法 外科治疗 2 6例 HC,对行病变胆管切除的 8例作术后定期 TAI,同时观察肝动脉损害及 TAI的效果。结果 2 0例行病变胆管切除 ,切除率 77%。选择性肝动脉造影的结果显示 ,8例 HC均存在不同程度的肝动脉侵犯 ,常规的术前检查方法无法确定这种损害。其临床特征在术前即可存在 ,术后呈进行性加重 ,成为 HC病情迅速恶化和患者死亡的重要原因之一。术后定期的 TAI治疗可部分缓解 HC进行性肝动脉破坏 ,改善肝脏的供血。 结论 为进一步明确 HC的病变程度和合理选择术式 ,作者认为术前除 PTC,B超 ,CT和 ERCP等检查外 ,应尽可能做选择性肝动脉造影。而术后定期的肝动脉灌注化疗有可能进一步提高患者的远期生存率
Objective To understand the biological characteristics of Hiral cholangiocarcinoma (HC) invading peripheral vascular nerves and the effect of transcatheter hepatic artery perfusion (TAI) on HC. Methods Surgical treatment of 26 cases of HC was performed on 8 cases of pathological biliary tract resection after regular TAI, and the effects of hepatic artery injury and TAI were observed. Results Twenty patients underwent bile duct resection with a resection rate of 77%. The results of selective hepatic artery angiography showed that there were different degrees of hepatic artery invasion in 8 cases of HC. Conventional preoperative examination methods could not confirm this damage. Its clinical features can exist before surgery and are progressively worse after surgery, becoming one of the important causes of the rapid deterioration of HC and patient death. Regular TAI treatment after surgery can partially relieve HC progressive hepatic artery destruction and improve liver blood supply. Conclusions In order to further clarify the degree of HC lesions and reasonable choice of operation, the author believes that in addition to PTC, B-ultrasound, CT and ERCP examinations, selective hepatic arteriography should be performed as far as possible. And postoperative hepatic arterial infusion chemotherapy may further improve the patient’s long-term survival rate