肝门部胆管癌手术治疗体会.doc

肝门部胆管癌手术治疗体会 　 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32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 32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85.71%、77.78%、57.14%、100.00%、50.00%。手术切除24例中联合肝叶切除11例，血管切除4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 　　Experience in the Surgical Treatment of 32 Cases with Hilar Cholangiocarcinoma 　　Abstract：Objective To investigate the operative procedures of hilar cholangiocarcinoma and the affecting factors.Methods The growth type, pathologic type, procedures and factors that affecting the procedures of 32 cases were analyzed retrospectively.Results The gross morphology include 3 papillary adenocarcinomas, 5 nodular lesions, 22 sclerosing lesions and 2 pervasive lesions. The portal vein invasion appeared in 9 cases, among which the liver parenchyma invasion in 2 cases and 1 patient had intrahepatic metastases. The hepatic artery invasion occurred in 2 cases. Thirtytwo cases in which 9 were well differentiated, 16 moderate differentiated and 7 poor differentiated. All the patients were classified according to the Bismuth standard with the results as 7 in type I, 9 in type Ⅱ, 7 in type Ⅲa, 5 in type Ⅲb, 4 in type Ⅳ,and the resection rate was 85.71%,77.78%, 57.14%, 100.00%, 50%, respectively. Twentyfour patients acquired resections, among which 11 had hepatectomy combined with, 4 patients were performed vascular reconstruction, and 18 patients underwent radical resection, 2 patients died in the admission period, 1 developed bile leakage.Conclusion Hilar cholangiocarcinomas, the majority of which were well differentiated and moderate differentiated adenocarcinomas, mainly encroach into hepatic bile duct longitudinally, invade the surrounding vascular and the liver parenchyma. The length of invasion