小范围切除治疗Bismuth Ⅱ、Ⅲ型肝门部胆管癌的临床观察
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摘要
目的探讨小范围切除治疗BismuthⅡ、Ⅲ型肝门部胆管癌的临床效果及安全性。方法选取2009年5月至2012年5月本院收治的80例BismuthⅡ、Ⅲ型肝门部胆管癌患者,按照手术切除范围的不同分为小范围组与大范围组,每组40例,比较分析两组围术期指标、术后并发症发生率及术后5年生存情况。结果小范围组术中出血量少于大范围组,手术时间及住院时间短于大范围组,差异有显著性(P<0.05)。小范围组术后并发症发生率(5.0%)低于大范围组(15.0%),差异有显著性(P<0.05)。两组术后总胆红素、谷丙转氨酶、谷草转氨酶水平及1、3、5年生存率比较差异无显著性(P>0.05)。结论与大范围切除比较,小范围切除治疗BismuthⅡ、Ⅲ型肝门部胆管癌能够改善围术期指标,降低并发症发生率,且不会降低5年生存率。
Objective To explore the clinical effect and safety of patients with Bismuth Ⅱ and Ⅲ patients with a small scale removal.Method Our hospital from May 2010 to May 2012 were admitted in the hepatic bile duct carcinoma Bismuth portal vein type Ⅱ, Ⅲ, 80 cases of patients, according to the different surgical methods into smaller groups with a wide range of groups, 40 cases in each group,compared two groups of perioperative, postoperative complications and follow-up of 5 years of survival rate. Result The incidence of complications was lower in small range and large scale group, and the difference was statistically signi? cant(P<0.05). The small scale group was shorter than the large scale group, the amount of blood was less in the operation and the length of the hospital was short, and the difference was statistically signi? cant(P<0.05). There were no signi? cant differences in survival rates in two groups after 1 year, 3 years and 5 years(P>0.05). Conclusion Small scale resection in the treatment of liver bile duct carcinoma Bismuth portal vein type Ⅱ,Ⅲ compared to patients with a wide range of resection can improve perioperative indicators, reduce the incidence of complications, and promise not to reduce the long-term survival rate of 5 years follow-up.
Objective To explore the clinical effect and safety of patients with Bismuth Ⅱ and Ⅲ patients with a small scale removal.Method Our hospital from May 2010 to May 2012 were admitted in the hepatic bile duct carcinoma Bismuth portal vein type Ⅱ, Ⅲ, 80 cases of patients, according to the different surgical methods into smaller groups with a wide range of groups, 40 cases in each group,compared two groups of perioperative, postoperative complications and follow-up of 5 years of survival rate. Result The incidence of complications was lower in small range and large scale group, and the difference was statistically signi? cant(P<0.05). The small scale group was shorter than the large scale group, the amount of blood was less in the operation and the length of the hospital was short, and the difference was statistically signi? cant(P<0.05). There were no signi? cant differences in survival rates in two groups after 1 year, 3 years and 5 years(P>0.05). Conclusion Small scale resection in the treatment of liver bile duct carcinoma Bismuth portal vein type Ⅱ,Ⅲ compared to patients with a wide range of resection can improve perioperative indicators, reduce the incidence of complications, and promise not to reduce the long-term survival rate of 5 years follow-up.
引文
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[11]丁国乾,秦鸣放,周富胜,等.两种方式姑息性治疗肝门胆管癌对比分析[J].重庆医学,2013,42(6):692-694.
[12]Walter T,Ho CS,Horgan AM,et al.Endoscopic or percutaneous biliary drainage for Klatskin tumors?[J].J Vasc Interv Radiol,2013,24(1):113-121.
[13]宗帝,曾勇.肝门胆管癌外科治疗疗效评价[J].华西医学,2013,28(9):1387-1388.
[2]丁国乾,秦鸣放,邹富胜,等.两种方式姑息治疗肝门胆管癌对比分析[J].重庆医学,2013,42(6):512-513.
[3]朱宏毅,季福,李可为,等.肝门胆管癌预后的影响因素分析[J].肝胆胰外科杂志,2012,24(2):92-95.
[4]彭承宏,程坤.肝门部胆管癌手术方式的正确选择[J].中华消化外科杂志,2012,11(1):11-14.
[5]李可为,施维锦.肝门胆管癌的姑息性治疗[J].肝胆胰外科杂志,2015,27(6):90-91.
[6]Kawashima H,Itoh A,Ohno E,et al.Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma:a retrospective study of efficacy and risk factors related to complications[J].Ann Surg,2013,257(1):121-127.
[7]Li TF,Li Z,Han XW,et al.Combined T/Y biliary stent placement for the treatment of biliary obstruction caused by Bismuth-Corlett type IV hilar cholangiocarcinoma[J].Hepatogastroenterology,2014,61(134):1519-1522.
[8]Lawson AJ,Beningfield SJ,Krige JE,et al.Percutaneous transhepatic self-expanding metal stents for palliation of malignant biliary obstruction[J].S Afr J Surg,2012,50(3):54-56.
[9]Maillard M,Novellas S,Baudin G,et al.Placement of metallic biliary endoprostheses in complex hilar tumours[J].Diagn Interv Imaging,2012,93(10):767-774.
[10]Sofue K,Arai Y,Takeuchi Y,et al.Safety and effi cacy of primary metallic biliary stent placement with tract embolization in patients with massive ascites:a retrospective analysis of 16 patients[J].JVasc Interv Radiol,2012,23(4):521-527.
[11]丁国乾,秦鸣放,周富胜,等.两种方式姑息性治疗肝门胆管癌对比分析[J].重庆医学,2013,42(6):692-694.
[12]Walter T,Ho CS,Horgan AM,et al.Endoscopic or percutaneous biliary drainage for Klatskin tumors?[J].J Vasc Interv Radiol,2013,24(1):113-121.
[13]宗帝,曾勇.肝门胆管癌外科治疗疗效评价[J].华西医学,2013,28(9):1387-1388.