小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验

摘要

目的 探讨小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床效果及安全性.方法 回顾性分析2007年5月至2017年5月在临沂市肿瘤医院肝胆外科接受手术切除的108例Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者资料,其中男性56例,女性52例,年龄(57.2±5.3)岁(范围:48～76岁).Ⅲa型51例,Ⅲb型40例,Ⅳ型17例.小范围肝切除(≤3个肝段切除)70例:肝脏4b段切除8例,4b段+5段切除28例,部分4段+部分7段切除+部分1段切除34例.大范围肝切除38例(＞3个肝段):肝脏2段+3段+4段+1段切除30例,5段+7段+8段+1段切除8例.不符合正态分布的计量资料采用t'检验进行统计学分析,对术后并发症发生率及1、3、5年累积总体生存率的统计采用x2检验.结果 (1)小范围肝切除组与大范围肝切除组相比,手术时间短[(180±25)min比(210±35)min](t'=4.676,P＜0.05),术中出血量少[(310±80)ml比(500±110) ml] (t'=9.385,P＜0.05).(2)小范围组与大范围组相比术后并发症发生率低(x2=5.230,P＜0.05).(3)小范围肝切除和大范围肝切除术后1、3、5年累积总体生存率分别为87.1％、58.4％、30.0％和84.2％、57.9％、31.6％,两组相比较无明显差异(x2 =0.177,P=0.674;x2 =0.005,P=0.946;x2=0.029,P=0.865).结论 小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌疗效确切,陈氏肝肠吻合法简单、安全、有效,可以广泛推广使用.%Objective To explore the clinical effect and safety of minor liver resection for hilar cholangiocarcinoma(HC) of Bismuth-Corlette type Ⅲ and Ⅳ.Methods From May 2007 to May 2017,the clinical data of 108 patients with Bismuth-Corlette type Ⅲ and Ⅳ HC underwent hepatectomy were collected and analyzed retrospectively.There were 56 males and 52 females,aged (57.2 ± 5.3)years(ranged 48-76 years).Among the 108 cases,there were 51 cases of type Ⅲ a,40 cases of type Ⅲ b and 17 cases of type Ⅳ.Small-scale hepatectomy(≤3 hepatectomy) was performed in 70 cases,including 8 cases of 4b segment resection,28 cases of 4b segment+5 segment resection,and 34 cases of partial 4 segment+partial 7 segment+partial 1 segment resection.Large-scale hepatectomy was performed in 38 cases(＞3 segments),of which 30 cases were treated with 2 segments+3 segments+4 segments+ 1 segment,and 8 cases were treated with 5 segments+7 segments+8 segments+ 1 segment.t'test was used to analyze the data which did not conform to the normal distribution,and x2 test was used to calculate the incidence of postoperative complications and the 1,3,and 5-year cumulative overall survival rate.Results (1) The operation time of minor liver resection group ((180±25)minutes) was shorter than that of major liver resection group ((210± 35) minutes) (t'=4.676,P＜0.05),the amount of blooding operation time of minor liver resection group ((310±80) ml) was less than that of major liver resection group ((500± 110)ml)in the operation(t'=9.385,P＜0.05),and the difference was statistically significant.(2)The incidence of complications was lower in minor liver resection group and major liver resection group,and the difference was statistically significant(x2=5.230,P＜0.05).(3) The actual 1-,3-and 5-year survival rates were 87.1％,58.4％,30.0％ and 84.2％,57.9％,31.6％,respectively.There were no significant differences in survival rates in two groups in 1-,3-and 5-year survival rates(x2 =0.177,P=0.674;x2 =0.005,P=0.946;x2 =0.029,P=0.865).Conclusions Compared to patients with major liver resection,Minor liver resection for selected patients with HC of Bismuth-Corlette Ⅲ and Ⅳ according to our criteria achieved better long-term outcomes.Chen's biliojejunostomy is a simple,effective and safe method,which can be widely used when there are multiple biliary intestinal anastomosese.