摘要
目的:对联合肝叶切除及肝门区域淋巴清扫治疗肝门部胆管癌的实际效果作初步观察。方法:回顾性分析1998年至2005年间86例肝门部胆管癌病人根治性切除的临床与随访资料。结果:全组男58例,女28例,平均年龄(51.0±9.4)岁。均行骨骼化淋巴清扫,根据是否附加患侧半肝和(或)尾状叶切除分为肝切除组(53例)和未切肝组(33例)。全组获R0根治34例,术后疗效明显优于非R0根治者。肝切除组各种并发症发生率明显高于未切肝组,但术后生存期无明显差异。肝门部胆管癌淋巴结转移率较高(54.7%),淋巴结转移与否与术后疗效明显相关。结论:肝叶切除及区域淋巴清扫是提高肝门部胆管癌根治性切除率的重要手段,但是否能够达到根治性切除还有其他影响因素,应审慎决定是否施行肝叶切除。肝门部胆管癌有较高的淋巴结转移率,骨骼化淋巴清扫应成为操作规范,但何谓彻底的淋巴清扫仍待界定。
Objective To examine the outcome of partial hepatectomy with regional lymphadenectomy for hilar cholangiocarcinoma. Methods The clinical and follow-up data of 86 patients who underwent radical resection for hilar cholangiocarcinoma during the period 1998-2005 were analyzed retrospectively. Results There were 58 men and 28 women, with an average age of 51 years. They underwent extrahepatic bile duct resection and regional lymphadenectomy with （hepatectomy group, n=53） or without partial hepatectomy （non-hepatectomy group, n=33）. Thirty-four patients received an Ro resection, and they presented a better prognosis than those who had an R1 or R2 resection. The hepatectomy group had a higher complication rate than the non-hepatectomy group, but the survival rate between the 2 groups did not show any statistically significant difference. Lymph node metastases were found in 47 patients （54.7%）, and lymph node involvement was shown to be an independent predictor of survival. Conclusions Partial hepatectomy and regional lymphadenectomy are important measures to improve the radical resection rate. But because many other factors intervene in reaching the goal of radical resection, it should be considerate to include partial hepatectomy in the procedure. Hilar cholangiocarcinoma has a high incidence of lymph node metastasis; skeletonization of the hepatoduodenal ligament should be a standard procedure in its radical resection. The extent of regional lymphadenectomy needs to be further elucidated.
出处
《外科理论与实践》
2005年第4期323-327,共5页
Journal of Surgery Concepts & Practice
关键词
胆管肿瘤
肝门
肝切除术
淋巴清扫术
Hilar cholangiocarcinoma
Hepatectomy
Regional lymphadenectomy
