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目的 探讨对中晚期胆囊癌积极进行外科治疗的价值。方法 对 34例中晚期胆囊癌 ,除行胆囊切除外 ,行肝段切除 7例、半肝切除 1例、肝门部胆管切除高位胆肠吻合 4例、肝段切除 +肝门部胆管切除高位胆肠吻合 6例、肝部分切除及胰头十二指肠切除 16例。其中同时行肝十二指肠韧带淋巴结骨骼化清扫 2 8例 ,行肾门淋巴结清扫 1例 ,行右半结肠切除 1例 ,行受累肝动脉切除2例。结果 手术均顺利完成 ,并发胆漏 6例 ,其中死于多器官功能衰竭 1例 ,经引流后愈合 5例 ;1例并发应激性溃疡出血。 12个月前手术者 17例 ,10例仍存活 ,其中 2例存活已超过 30个月 ,最长者达 48个月 ;17例 12个月内手术者 16例存活。结论 对中晚期胆囊癌积极进行手术治疗 ,能改善患者生活质量 ,延长生存期。
Objective To explore the value of aggressive surgical treatment of advanced gallbladder cancer. Methods Thirty-four patients with advanced gallbladder cancer were treated with cholecystectomy. Seven patients underwent hepatic resection, one hemihepatectomy, four high hepatic biliary-enteric anastomosis, and hepatectomy and hilar bile duct resection. There were 6 cases of biliary-enteric anastomosis, partial hepatectomy, and pancreatic head duodenal resection. Among them, 28 patients underwent ossification of the lymph nodes of the hepatoduodenal ligament, 1 patient underwent renal lymph node dissection, 1 patient underwent right hemicolectomy, and 2 underwent hepatic artery resection. Results All the operations were successfully completed. Biliary leakage occurred in 6 cases. Among them, one patient died of multiple organ failure, and 5 patients healed after drainage. One patient developed stress ulcer bleeding. Twenty-seven patients underwent surgery 12 months earlier. Ten patients survived. Two of them survived for more than 30 months and the longest was 48 months. Seventeen patients survived within 12 months of surgery. Conclusion The aggressive surgical treatment of advanced gallbladder cancer can improve the quality of life of patients and prolong the survival period.