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目的探讨区域性肝门阻断在Ⅲ型肝门部胆管癌根治性切除中的应用。方法回顾性分析2002年-2010年11月收治的49例III型肝门部胆管癌的临床资料,其中治疗组24例解剖第1、2、3肝门后进行区域性阻断后,行根治性切除;对照组25例不解剖第2、3肝门,行常规根治性切除。结果治疗组无围手术期死亡发生,术后发生胆漏2例,肺部感染2例,均经积极非手术治疗恢复。对照组围手术期死亡2例,肝断面出血1例,胆漏2例,肺部感染2例。术后获得随访40例,随访率为82%,平均生存时间26月(2～65月)。总胆红素≥300μmol/L的患者其并发症发生率明显高于胆红素<300μmol/L者(P<0.05)。结论当总胆红素≥300μmol/L时,手术前应作减黄处理;根治性切除是治疗肝门部胆管癌最有效的方法,区域性肝门阻断可明显降低手术出血量、死亡率及术后并发症的发生率。
Objective To investigate the application of regional hepatic hilar block in the radical resection of type Ⅲ hilar cholangiocarcinoma. Methods The clinical data of 49 cases of type III hilar cholangiocarcinoma admitted to our hospital from 2002 to 2010 were retrospectively analyzed. Twenty-four cases in the treatment group were divided into two groups, In the control group, 25 cases were not dissected the second and third hepatic vessels, and the conventional radical resection was performed. Results There was no perioperative death in the treatment group, two cases of postoperative bile leakage and two cases of pulmonary infection were recovered by active non-surgical treatment. In the control group, there were 2 cases of perioperative death, 1 case of hepatic hemorrhage, 2 cases of bile leakage and 2 cases of pulmonary infection. Follow-up was obtained after surgery in 40 cases, the follow-up rate was 82%, the average survival time of 26 months (2 to 65 months). Complications of patients with total bilirubin≥300μmol / L were significantly higher than those with bilirubin <300μmol / L (P <0.05). Conclusion When the total bilirubin ≥ 300μmol / L, the operation should be reduced before treatment; radical resection is the most effective method of treatment of hilar cholangiocarcinoma, regional hepatic portal obstruction can significantly reduce the amount of surgical bleeding, mortality And the incidence of postoperative complications.