胆囊癌肝胰十二指肠联合切除严重并发症分析与处理.pdfVIP

腹部外科2016 年第 29 卷第 5 期 Fu Bu Wai Ke , Oct. 2016 , Vol. 29 , No.5 • 339 • ·论著· (胆道外科专题) 胆囊癌肝膜十二指肠联合切除 严重并发症分析与处理 段伟宏来运钢刘军桂杨硕刘翔金奎雷磊 [摘要] 目的 探索肝膜十二指肠联合切除(hepatopancreatoduQdenectomy， HPD)术对胆囊癌 (Nevin N)的治疗价值。方法对 19 例胆囊癌病人行 HPD 术，术前酌情行门静脉栓塞(portal vein embolization ,PVE) ，行经皮经肝穿刺胆道引流术(percutaneous transhepatic cholanic drainage ,PTCD) 减黄;观察术中、术后有无严重并发症及术后生存时间。结果 19 例 HPD病人未出现术中大出血、 死亡等并发症，但 1 例病人术后出现肺栓塞猝死，1 例肝衰竭，1 例术后出现严重的肺部感染死亡，其 余病人不同程度出现胆瘦及膜瘦等并发症。结论 HPD 手术对胆囊癌达到 RO 切除有较大价值，能 明显提高病人生存时间，但术后有严重的并发症及较高的病死率，需谨慎实施。 [关键词] 胆囊癌p 肝膜十二指肠切除术F 黄瘟;肝衰竭 [中图分类号] R657.4 [文献标识码] A [∞1] 10. 3969/j. is皿 1003-5591.2016.05.006 Analysis of serious compliωtions following HPD of gaIIbladder cancer Duan Weihong , Lai Yungang , Liu ] ungui , Yang Shuo , Liu Xiang , ] in Kui , Lei Lei. Department 0/ Hepatobiliary Surgery , PLA Rocket Forçe 仇neral Hos户ω， Beijing 100088 , China Corresponding author: Duan Weihong , Email: changxinzhong@ 163.com [Abstract] Objective To explore the values of hepatopancreatoduodenectomy (HPD) in the treatment of the gallbladder carcinorna with Nevin stage N. Meth叫s From Jan. 2014 to July 2016 , the clinical data of 19 cases of gallbladder carcinoma with Nevin stage N undergoing HPD were retro- spectively. Preoperative portal vein embolization (PVE) was performed in 4 patients and percutaneous transhepatic cholanic drainage(PTCD) was applied in 13 patients in order to improve the resectability. Peri- and postσoperativ complications and postoperative survival were observed. Results HPD was successfully performed on all 19 cases of gallbladder carcinorna without peri-operative rnassive bleed ing , deaths , etc. Postoperatively , there was one death due to pulmonary embolism , one death due to