肝门部胆管癌的手术治疗体会

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1、肝门部胆管癌的手术治疗体会作者：浦涧，汪建初，韦建宝，李良波，韦忠恒，韦邦宁，卢冠铭【摘要】　　目的探讨肝门部胆管癌的手术切除方式及影响手术切除的因素。方法回顾性分析2例肝门胆管癌的生长方式，病理类型，手术方式及影响手术切除的因素。结果2例中大体病理呈乳头状3例，结节型5例，硬化型22例，弥漫性癌2例；侵犯门静脉9例，其中侵犯肝组织2例，肝内转移1例；侵犯肝动脉2例。组织学呈高分化腺癌9例，中分化腺癌16例，低分化腺癌7例。按Bismuth分型:Ⅰ型7例,Ⅱ型9例，Ⅲa型7例、Ⅲb型5例，Ⅳ型4例，切除率分别是%、%、%、%、%。手术切除24例中联合肝叶切除11例，血管切除4

2、例，获根治性切除18例，住院期死亡2例，术后胆漏1例。结论肝门胆管癌以高、中分化腺癌多见，主要沿胆管壁浸润生长，常横向侵犯周围血管及肝组织。影响手术切除的主要因素是肿瘤向近端胆管壁浸润长度、门静脉受累情况及肝功能耐受能力。联合肝段和血管切除可以提高根治性切除率。【关键词】肝门胆管癌　肝切除　血管重建ExperienceintheSurgicalTreatmentofCaseswithHilarCholangiocarcinomaAbstract：ObjectiveToinvestigatetheoperativeproceduresofhilarcholangiocarcin

3、omaandtheaffectingThegrowthtype,pathologictype,proceduresandfactorsthataffectingtheproceduresofcaseswereanalyzedThegrossmorphologyincludepapillaryadenocarcinomas,nodularlesions,sclerosinglesionsandpervasivelesions.TheportalvEininvasionappearedincases,amongwhichtheliverparenchymainvasioninca

4、sesand1patienthadintrahepaticmetastases.Thehepaticarteryinvasionoccurredincases.Thirtytwocasesinwhichwerewelldifferentiated,1moderatedifferentiatedandpoordifferentiated.AllthepatientswereclassifiedaccordingtotheBismuthstandardwiththeresultsasintypeI,intypeⅡ,intypeⅢa,intypeⅢb,intypeⅣ,andth

5、eresectionrate%,%,%,%,0%,respectively.Twentyfourpatientsacquiredresections,amongwhich11hadhepatectomycombinedwith,patientswereperformedvascularreconstruction,and1patientsunderwentradicalresection,patientsdiedintheadmissionperiod,1developedbileHilarcholangiocarcinomas,themajorityofwhichwere

6、welldifferentiatedandmoderatedifferentiatedadenocarcinomas,mainlyencroachintohepaticbileductlongitudinally,invadethesurroundingvascularandtheliverparenchyma.Thelengthofinvasiontotheproximalduct,portalvEIn,andtheliverfunctionreservewerethemainfactorsthataffectingthesuccessofresection.Combine

7、dhepatectomyandvascularreconstructioncanhelptoincreasetherateofradicalresection.Keywords：Hilarcholangiocarcinoma;Hepatectomy;Vascularreconstruction　0引言　　肝门部胆管癌是胆道最常见的恶性肿瘤，因其位置深以及肝门部特殊的解剖关系，肿瘤极易侵犯肝门部血管和肝实质，早期不易诊断，手术切除率低，影响了病人的生存期。近几年来，由于影像学诊断技术的发展和手术上的改进，