腹腔镜Bismuth Ⅲ、Ⅳ型肝门部胆管癌根治术初步体会(附10例报告)OACSTPCD
Primary experience of laparoscopic radical resection of Bismuth Ⅲ and Ⅳ perihilar cholangiocarcinoma:with a report of 10 patients
目的:总结腹腔镜Bismuth Ⅲ、Ⅳ型肝门部胆管癌根治术的可行性与安全性.方法:回顾分析 2017 年 12 月至2021 年4 月为10 例Bismuth Ⅲ、Ⅳ型肝门部胆管癌患者行腹腔镜根治术的临床资料.结果:10 例患者中男6 例,女4 例.根据术前影像资料诊断,Ⅲa 型1 例、Ⅲb 型7 例、Ⅳ型2 例.均顺利完成腹腔镜肝门部胆管癌根治术,其中 1 例行右半肝切除+胆肠吻合,6 例行左半肝切除+胆肠吻合术,1 例行左半肝切除+胆肠吻合+肝右动脉右前分支修补术,1 例行扩大左半肝切除+胆肠吻合术,1 例行围肝门切除+胆肠吻合术,均同期切除尾叶.手术时间平均(623.5±162.1)min,术中出血量平均(605.0±457.3)mL.术后发生并发症2 例,其中B级胆漏伴发热1 例,低蛋白血症伴贫血1 例;围手术期无非计划再次手术及死亡病例.术后病理示腺癌9 例、浸润性囊内乳头状癌1 例.R0 切除率90%.根据美国癌症联合委员会第8 版分期标准Ⅰ期3 例、Ⅱ期3 例、ⅢB 期1 例、ⅢC 期2 例、ⅣA 期1 例.截至2023 年4 月,随访7～45 个月,中位随访时间12 个月,失访1 例,术后肿瘤复发转移6 例,死亡5 例.结论:对于具有丰富腹腔镜手术经验的医师,腹腔镜Bismuth Ⅲ、Ⅳ型肝门部胆管癌根治术安全、可行,但术前应严格筛选病例.
Objective:To summarize the feasibility and safety of laparoscopic radical resection of Bismuth types Ⅲ and Ⅳ peri-hilar cholangiocarcinoma.Methods:Clinical data of 10 patients with Bismuth types Ⅲ and Ⅳ perihilar cholangiocarcinoma who under-went laparoscopic radical surgery from Dec.2017 to Apr.2021 were retrospectively analyzed.Results:This study included 6 males and 4 females.According to preoperative image data,Bismuth types Ⅲa,Ⅲb,Ⅳ were found in 1,7 and 2 patients,respectively.All surgeries were completed successfully.Right hemihepatectomy and biliary-intestinal anastomosis was performed in 1 patient,left hemihepatectomy and biliary-intestinal anastomosis was performed in 6 patients,left hemihepatectomy and bilioenteric anastomosis and repair of the right anterior branch of the right hepatic artery was performed in 1 patient,extended left hemihepatectomy and biliary-intestinal anastomosis was performed in 1 patient,and periportal hepatectomy and biliary-intestinal anastomosis was performed in 1 patient.Caudate lobectomy was performed simultaneously in all patients during surgery.The mean operation time was(623.5±162.1)min,and mean intraoperative blood loss was(605.0±457.3)mL.There were 2 postoperative complications,including 1 grade B biliary leakage with fever and 1 hypoproteinemia with anemia.There were no unplanned reoperation or death patients in perioperative period.Postoperative pathologi-cal result revealed bile duct adenocarcinoma in 9 patients and invasive intracapsular papillary carcinoma in 1 patient.R0 resection rate was 90％.According to the AJCC8th edition staging criteria for perihilar cholangiocarcinoma,there were3 cases of stageⅠ,3 cases of stage Ⅱ,1 case of stage ⅢB,2 cases of stage ⅢC,and 1 case of stageⅣA.Up to Apr.2023,1 of 10 patients was lost to follow-up,with a follow-up time of 7 to 45 months and a median follow-up time of 12 months.6 patients had tumor recurrence and metastasis after surgery,and 5 of them died.Conclusions:Laparoscopic radical resection of Bismuth Ⅲ and Ⅳ perihilar cholangiocarcinoma remains extremely challenging,but it is generally safe and feasible for surgeons with extensive laparoscopic experience,but patients should be rigorously screened preoperatively.
王建军;曾新桃;王德才;邓澜;彭永海;陈熙;陈思瑞;胡朝辉;罗华;杨培
电子科技大学医学院附属绵阳医院 绵阳市中心医院肝胆外科,四川 绵阳,621000
临床医学
肝门部胆管癌腹腔镜检查根治性切除术安全性
Hilar cholangiocarcinomaLaparoscopyRadical resectionSafety
《腹腔镜外科杂志》 2024 (004)
256-262 / 7
绵阳市中心医院孵化课题(2022FH010);绵阳市中心医院人才引进课题(2023RCYJ-001)
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