切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 457 -459. doi: 10.3877/cma.j.issn.1674-3946.2021.04.029

论著

肝动脉和门静脉切除重建在肝门部胆管癌根治术中疗效的比较
何平1, 张波2, 董科3, 罗金辉1, 李钢1, 刘波1,()   
  1. 1. 611730 成都,成都市郫都区人民医院(成都医学院第三附属医院)肝胆胰外科
    2. 611730 成都,成都市郫都区人民医院内一科
    3. 610015 成都,四川省人民医院肝胆胰外科
  • 收稿日期:2020-08-23 出版日期:2021-08-17
  • 通信作者: 刘波

Therapeutic effect of hepatic artery and portal vein resection and reconstruction in the radical operation of hilar cholangiocarcinoma

Ping He1, Bo Zhang2, Ke Dong3, Jinhui Luo1, Gang Li1, Bo Liu1,()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, the People’s Hospital of Pidu District, Chengdu (The Third Affiliated Hospital of Chengdu Medical College), Sichuan 611730, China
    2. The First Department of Internal Medicine, Pidu District People’s Hospital, Sichuan 611730, China
    3. Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People’s Hospital, Sichuan 610015, China
  • Received:2020-08-23 Published:2021-08-17
  • Corresponding author: Bo Liu
引用本文:

何平, 张波, 董科, 罗金辉, 李钢, 刘波. 肝动脉和门静脉切除重建在肝门部胆管癌根治术中疗效的比较[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(04): 457-459.

Ping He, Bo Zhang, Ke Dong, Jinhui Luo, Gang Li, Bo Liu. Therapeutic effect of hepatic artery and portal vein resection and reconstruction in the radical operation of hilar cholangiocarcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 457-459.

目的

研究肝动脉和门静脉切除重建在肝门部胆管癌(HC)根治术中的意义。

方法

回顾性分析2011年1月至2019年7月接受手术治疗的183例患者临床资料,依据术式分为以下三组:A组(78例,姑息手术);B组(56例,门静脉重建);C组(49例,肝动脉重建)。采用SPSS22.0统计软件对数据进行分析。三组术后并发症发生率的比较采用χ2检验,Kaplan-Meier法进行术后生存分析,P<0.05为差异有统计学意义。

结果

所有患者平均中位随访时间为39.5个月,姑息手术组、门静脉重建组和肝动脉重建组5年生存率分别为22.3%、45.7%和51.2%,门静脉重建组和肝动脉重建组差异无统计学意义,但均高于姑息手术组(P<0.05)。姑息手术组、门静脉重建组和肝动脉重建组并发症发病率分别为73.1%、66.1%和71.4%,差异无统计学意义(P>0.05)。在90 d死亡率比较上,三组分别为10.3%、3.6%、6.1%,差异无统计学意义(P>0.05)。

结论

门静脉重建术和肝动脉重建术的治疗效果无论是并发症还是死亡率都要优于姑息手术组。

Objective

To investigate the significance of hepatic artery and portal vein resection and reconstruction in the radical operation of hilar cholangiocarcinoma (HC).

Method

A retrospective analysis of the clinical data of 183 patients who underwent surgical treatment from January 2011 to July 2019, were performed. Patients were divided into the following three groups according to the surgical procedure: Group A (78 cases, palliative surgery); Group B (56 cases, portal vein reconstruction); Group C (49 cases, hepatic artery reconstruction). The data was analyzed by using SPSS22.0 statistical software. The incidence of postoperative complications in the three groups was examined by using χ2 test. Kaplan-Meier method was used for postoperative survival analysis. A P value of <0.05 was considered as statistically significant difference.

Result

The incidence of complications in the palliative surgery group, portal vein reconstruction group, and hepatic artery reconstruction group were 73.1%, 66.1%, and 71.4% respectively, (P>0.05). In comparison of the 90-day mortality rate, the three groups were 10.3%, 3.6%, and 6.1% respectively(P>0.05).

Conclusion

Portal vein reconstruction and hepatic artery reconstruction are better than the palliative surgery group in terms of complications and mortality.

表1 183例HC患者不同术式三组患者一般资料比较[(±s),例]
表2 183例HC患者不同术式三组患者术后并发症发生率比较(例)
[1]
Gao Y, Xu D, Wu Y-S, et al. Increasing negative lymph node count is independently associated with improved long-term survival in resectable perihilar cholangiocarcinomas[J]. Medicine(Baltimore), 2019, 98(15): e14943.
[2]
张耀东,李相成. 合并血管切除重建的肝门部胆管癌根治术[J]. 中华肝胆外科杂志,2018,24(2):135-139.
[3]
王要轩,李珂,田玉伟,等. 联合肝脏离断和门静脉结扎的二步肝切除技术并肝动脉重建治疗肝门部胆管癌[J]. 中华肝胆外科杂志,2018,24(9):600-603.
[4]
刘涛,常琪,李晓勇. 加速康复外科对肝门部胆管癌根治术的应用效果及并发症影响[J/CD]. 中华普外科手术学杂志(电子版),2020,14(3):244-247.
[5]
Sugiura, T, Okamura Y, Ito T, et al. Left Hepatectomy with Combined Resection and Reconstruction of Right Hepatic Artery for Bismuth Type I and II Perihilar Cholangiocarcinoma[J]. World J Surg, 2019, 43(3): 894-901.
[6]
Lahat E, Jaber A, Salloum C, et al. Porto-Rex Shunt for Left Portal Vein Reconstruction During Right Extended Hepatectomy for Advanced Extrahepatic Biliary Cancer[J]. World J Surg, 2019, 43(4): 1117-1120.
[7]
汪昱,董科. 改良腹腔镜脾脏切除+贲门周围血管离断术在肝硬化合并门静脉高压症中的应用研究[J/CD]. 中华普外科手术学杂志(电子版),2021,15(1):65-68.
[8]
王瑶,肖凤鸣,吴孟航,等. 下腔静脉右侧入路建立肝脏悬吊系统的腹腔镜右半肝切除术的临床研究[J/CD]. 中华普外科手术学杂志(电子版),2021,15(1):61-64.
[9]
张秋学,刘汝海,李学锋,等. 半肝联合肝动脉切除治疗Bismuth Ⅲ、Ⅳ型肝门胆管癌43例[J]. 中华普通外科杂志,2013,28(11):819-821.
[10]
Nagino M, Nimura Y, Nishio H, et al. Hepatectomy With Simultaneous Resection of the Portal Vein and Hepatic Artery for Advanced Perihilar Cholangiocarcinoma[J]. Ann Surg, 2010, 252(1): 115-123.
[11]
刘百铭,苏洋. 肝门部胆管癌手术治疗争议点的研究现状[J]. 中国医师进修杂志,2019,42(5):467-470.
[12]
吴若林,方翊天,陈灿灿,等. 22例肝门部胆管癌外科手术治疗分析[J]. 肝胆外科杂志,2018,26(6):414-418.
[13]
戴海粟,别平,王曙光,等. 联合肝动脉切除重建在肝门部胆管癌根治术中的临床研究[J]. 中华外科杂志,2018,56(1):41-46.
[14]
邱建国,李明,史政荣,等. 门静脉动脉化在肝门部胆管癌根治术中的应用价值[J]. 中国普外基础与临床杂志,2018,25(2):221-224.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 徐保平, 彭怀文, 喻怀斌, 王晓涛. 新型冠状病毒肺炎继发糖尿病酮症酸中毒合并肝门静脉积气一例[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 250-255.
[3] 王卫东. 贲门周围血管离断与左膈下静脉的保留[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 464-464.
[4] 叶美妮, 刘思嘉, 臧玉玮, 刘云建. 肝硬化门静脉血栓形成的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 379-384.
[5] 汤宏涛, 何坤. 中晚期肝细胞癌介入治疗的进展及前景[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 305-308.
[6] 徐楠, 杨云川, 周迟, 马翔, 鲁正, 崔培元. 脾动脉结扎在肝门胆管癌行大范围肝切除中的临床作用研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 271-274.
[7] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[8] 林巧, 周丽. RFA联合LAH术治疗原发性肝癌并门静脉癌栓的临床效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 521-524.
[9] 陆朝阳, 金也, 孙备. 腹腔镜解剖性肝切除的发展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 363-366.
[10] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[11] 王飞, 陈政, 余德才, 曹亚娟. 原发性肝癌合并门静脉高压症的微创手术治疗[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 306-310.
[12] 蔡艺丹, 方坚, 张志强, 陈莉, 张世安, 夏磊, 阮梅, 李东良. 经颈静脉肝内门体分流术对肝硬化门脉高压患者肠道菌群及肝功能的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(05): 285-293.
[13] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[14] 梁艳娉, 陈燕柔, 梁运啸, 白飞虎, 吴斌, 王省. 华南地区门静脉高压食管胃静脉曲张出血内镜治疗现状调研分析[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 390-395.
[15] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
阅读次数
全文


摘要