肝胰十二指肠切除术在中晚期胆囊癌治疗中的应用

摘要

Gallbladder cancer has many characteristics such as rapid progression, difficult early diagnosis, low R0 resection rate, and poor prognosis.In recent years, extended radical resections including hepatopancreatoduodenectomy (HPD) have been performed for patients with advanced gallbladder carcinoma that invades the common bile duct, duodenum, and portal vein, but with no distant metastasis in many large medical centers.This procedure can significantly increase the R0 resection rate and prolong the survival time of patients.But due to the high rate of complications and high mortality in the patients treated with HPD, many surgeons still have little confidence in this procedure.This article reviews the current application of HPD in advanced gallbladder cancer, related problems, complications, and surgical indications, and suggests that HPD can be selected according to strict surgical indications.%胆囊癌进展迅速,早期诊断较为困难,R0切除率低,预后较差.近年来有不少大型医疗中心对累及胆总管、十二指肠、门静脉等而无远处转移的中晚期胆囊癌患者施行包括肝胰十二指肠切除术(HPD)在内的扩大根治术,显著提高了R0切除率,延长了患者生存期,但由于HPD的高并发症和病死率,不少外科医生依然对此缺乏信心.就HPD在中晚胆囊癌中的应用现状﹑存在的问题﹑并发症和手术指征等问题进行了综述,认为在严格选择患者及把握手术适应证的基础上,HPD是可行的.