精准外科技术在肝门部胆管癌手术治疗中的应用
安东均 安琳 张成 门定坤 晁延军
摘 要
目的：探讨精准外科技术在肝门部胆管癌手术治疗中的应用及治疗效果。
方法：回顾性分析2007年5月～2012年12月应用精准外科技术行手术治疗的44例肝门部胆管癌患者的临床资料。
结果：44例患者中行R0切除19例（43.2%），R1切除7例，R2切除5例，姑息性手术5例，活检加内/外引流8例；联合肝切除18例，联合肝固有动脉切除重建2例。手术平均用时为（5.8±1.6）h，术中平均出血量为（810±509）mL，术后发生各种并发症 28例次，术后1个月内死亡1例（1/44）。39例患者获得随访4～62个月，总体术后1年、3年、5年生存率分别为67.7%，30.8%，10.6%。R0根治性切除者术后1年、3年、5年生存率分别为93.3%，43.2%，13.9%。非根治性切除手术术后1年、3年、5年生存率分别为50.5%，26.8%，0，获R0根治性切除者生存率明显高于非根治性手术患者（x2=4.61，P＜0.05）；联合肝叶切除术后1年、3年、5年生存率分别为94.1%，52.7%，11.8%，未行联合肝叶切除的术后1年、3年、5年生存率分别为69.2%，25.4%，0，前者生存率明显高于后者（x2=15.26，P＜0.05）。
结论：精准外科技术在肝门部胆管癌手术治疗中的应用，可提高其根治性手术切除率，减少术后并发症的发生率，改善治疗效果。
关键词
胆管肿瘤/外科学；胆管肿瘤/治疗；精准外科
Application of precise surgical technique in surgical treatment of hilar cholangiocarcinoma
AN Dongjun，AN Lin，ZHANG Cheng，MEN Dingkun，CHAO Yanjun
（1.Department of Hepatobiliary Surgery，the Center Hospital of Xianyang City，Xianyang，Shannxi 712000，China；2.School of Statistics，Xian University of Finance and Economics，Xi'an 710100，China）
Corresponding author:AN Dongjun，Email:1158011981@qq.com
ABSTRACT
Objective:To investigate the application and clinical efficacy of precise surgical technique in surgical treatment of hilar cholangiocarcinoma.
Methods:The clinical data of 44 patients with hilar cholangiocarcinoma who received precise surgical treatment from May 2007 to December 2012 were retrospectively analyzed.
Results:Of the 44 patients，19 cases（43.2% ）received R0 resection，7 cases underwent R1resection，5 cases had R2 resection，5 cases were subjected to a palliative operation，and 8 cases were treated with biopsy and internal or external drainage；18 cases underwent combined liver resection，and 2 cases had simultaneous hepatic artery resection and reconstruction.The average operative time was（5.8±1.6）h and aver-age intraoperative blood loss was（810±509）mL.Postoperative complications occurred in 28 cases and one case（1/44）died within one month.Thirty-nine patients were followed up for 4-62 months，and the overall 1-，3-and 5-year survival rates were 67.7%，30.8%and 10.6%，respectively.The 1-，3-and 5-year survival rates for patients with R0 resection were 93.3%，43.2%and 13.9%，and for patients undergoing non-radical resection were 50.5% ，26.8%and 0，respectively，and the postoperative survival in patients with R0 resection was significantly better than that in patients with non-radical resection（x2=4.61，P＜0.05）；the 1-，3-and 5-year survival rates for patients who underwent combined lobectomy were 94.1%，52.7%and 11.8%，and for patients without combined lobectomy were 69.2%，25.4%and 0 respectively，and the patients who received combined lobectomy had a significantly better postoperative survival rate than those without combined lobectomy（x2=15.26，P＜0.05）.
Conclusion:Use of precise surgical technique in surgical treatment of hilar cholangiocarcinoma can increase the radical resection rate，reduce postoperative complications and improve the therapeutic outcomes.
KEY WORDS
Bile Duct Neoplasms/surg；Bile Duct Neoplasms/therapy；Precise Surgery
当今外科治疗正发生着从传统经验外科向现代精准外科转型的重大变革。随着精准肝切除术的广泛开展，精准外科技术对肝门部胆管癌的手术治疗亦产生了重大影响。笔者2007年5月～2012年12月应用精准外科技术行手术治疗44例肝门部胆管癌患者，报告如下。