完全腹腔镜下肝门部胆管癌根治术14例经验总结
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摘要
目的探讨完全腹腔镜下肝门部胆管癌根治术的可行性、安全性及临床疗效。方法回顾性收集2016年4月至2018年6月期间徐州医科大学附属医院肿瘤外科行全腹腔镜下肝门部胆管癌根治术14例患者的临床资料并分析总结,其中BismuthⅠ型7例Ⅱ型5例Ⅲb型2例。结果 14例患者均顺利完成了全腹腔镜下肝门部胆管癌根治手术,手术时间为190～400 min(中位数为285 min),术中出血量为100～500 mL(中位数为175 mL);无围手术期死亡病例,术后病理学检查均提示胆管腺癌,切缘均为阴性;淋巴结检出数为6～15枚/例(中位数为8枚/例),3例患者存在肿瘤周围区域淋巴结转移;术后2例患者出现胆汁渗漏,其中1例合并腹腔感染,均保守治疗后痊愈出院。术后患者经3～24个月(中位随访时间16个月)的定期随访,1例术后12个月时肿瘤复发,其余患者至今生存良好。结论在有经验的腹腔镜医师操作下,全腹腔镜下肝门部胆管癌根治术是安全可行的,且近期效果较好。
Objective To investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods Retrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ,5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb. Results Total laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190–400 min(median time of 285 min) and the amount of intraoperative blood loss was 100–500 mL(median amount of 175 mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6–15 per case(median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3–24 months(median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far. Conclusion Under the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.
Objective To investigate the feasibility, safety and clinical effect of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods Retrospectively summarized the 14 patients with hilar cholangiocarcinoma, who underwent total laparoscopic radical resection of hilar cholangiocarcinoma in the Affiliated Hospital of Xuzhou Medical University from April 2016 to June 2018. Collected the clinical data of those patients, including 7 cases of Bismuth type Ⅰ,5 cases of Bismuth type Ⅱ, and 2 cases of Bismuth type Ⅲb. Results Total laparoscopic radical resection of hilar cholangiocarcinoma were performed successfully in all 14 patients. The operative time was 190–400 min(median time of 285 min) and the amount of intraoperative blood loss was 100–500 mL(median amount of 175 mL). There was no death case during the perioperative period. Postoperative pathological results showed that all cases accorded with bile duct adenocarcinoma, resection margins of them were negative, amount of lymph node was detected 6–15 per case(median amount of 8 per case), and 3 patients were inspected with peritumoral lymph node metastasis. Two patients were combined with postoperative bile leakage, one of whom was complicated with an abdominal infection, and both were cured and discharged after conservative treatment. All patients were followed-up regularly within 3–24 months(median followed-up period of 16 months). One of them recurred within 12 months after the operation. The remaining patients have survived well so far. Conclusion Under the operation of the experienced surgeon, total laparoscopic radical resection of hilar cholangiocarcinoma is safe, feasible and effective in the short term.
引文
1Groot Koerkamp B, Fong Y. Outcomes in biliary malignancy. J1Surg Oncol, 2014, 110(5):585-59.
2朱鸿超,匡天佐,张福扬,等.全腹腔镜BismuthI型肝门部胆管癌根治术7例.中国微创外科杂志, 2018, 18(3):274-276.
3张成武,刘杰.完全腹腔镜下Ⅲa型肝门部胆管癌根治|生切除术.中国普通外科学杂志, 2017, 32(8):691-693.
4蔡秀军.美国癌症联合会(AJCC)癌症分期手册第8版“肝门部胆管癌”部分更新解读.临床外科杂志, 2018, 26(1):10-12.
5张辉,王梦龙.肝门部胆管癌的可切除性评估.中华肝胆外科杂志, 2015, 21(11):789-792.
6Cho MS, Kim SH, Park SW, et al. Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma:10-year single-institution experience. J Gastrointest Surg,2012, 16(9):1672-1679.
7刘召波,卢实春.肝门部胆管癌的外科治疗.中华消化外科杂志,2013, 12(3):186-190.
8郝志强,季德刚,孟子辉,等.肝门部胆管癌不同治疗方法的疗效.中华肝胆外科杂志, 2017, 23(8):517-520.
9Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10):2451-2459.
10刘清华,汪凌. 87例肝门部位胆管癌手术切除的诊疗分析.胃肠病学和肝病学杂志, 2018, 27(7):804-807.
11周宁新,黄志强,张文智,等. 402例肝门部胆管癌临床分型、手术方式及远期疗效的综合分析.中华外科杂志, 2006, 44(23):1599-1603.
12中国医师协会外科医师分会胆道外科医师委员会.胆道手术加速康复外科专家共识(2016版).中华消化外科杂志, 2017, 16(1):6-13.
13Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma:value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation.Radiology, 2014, 270(3):768-776.
14中国抗癌协会.肝门部胆管癌规范化诊治专家共识(2015).中华肝胆外科杂志, 2015, 21(8):505-511.
15黄华明,赵平.肝门部胆管癌手术切除范围的研究进展与争议.中华肝胆外科杂志, 2018, 24(1):67-70.
165Noji T, Tsuchikawa T, Okamura K, et al. Surgical outcome of hilar plate resection:extended hilar bile duct resection without hepatectomy. J Gastrointest Surg, 2014, 18(6):1131-1137.
17张辉,王孟龙.单中心56例肝门部胆管癌的外科治疗.中华肝胆外科杂志, 2017, 23(1):16-19.
18鲁敏,秦兴雷,蔡建平,等. 89例肝门部胆管癌术后并发症分析.中华普通外科学杂志, 2015, 30(7):535-537.
19杜羽升,赵文星,王骥,等.完全腹腔镜手术治疗肝门部胆管癌(附6例报道).中国普外基础与临床, 2017, 24(12):1487-1491.
2朱鸿超,匡天佐,张福扬,等.全腹腔镜BismuthI型肝门部胆管癌根治术7例.中国微创外科杂志, 2018, 18(3):274-276.
3张成武,刘杰.完全腹腔镜下Ⅲa型肝门部胆管癌根治|生切除术.中国普通外科学杂志, 2017, 32(8):691-693.
4蔡秀军.美国癌症联合会(AJCC)癌症分期手册第8版“肝门部胆管癌”部分更新解读.临床外科杂志, 2018, 26(1):10-12.
5张辉,王梦龙.肝门部胆管癌的可切除性评估.中华肝胆外科杂志, 2015, 21(11):789-792.
6Cho MS, Kim SH, Park SW, et al. Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma:10-year single-institution experience. J Gastrointest Surg,2012, 16(9):1672-1679.
7刘召波,卢实春.肝门部胆管癌的外科治疗.中华消化外科杂志,2013, 12(3):186-190.
8郝志强,季德刚,孟子辉,等.肝门部胆管癌不同治疗方法的疗效.中华肝胆外科杂志, 2017, 23(8):517-520.
9Kang MJ, Jang JY, Chang J, et al. Actual long-term survival outcome of 403 consecutive patients with hilar cholangiocarcinoma. World J Surg, 2016, 40(10):2451-2459.
10刘清华,汪凌. 87例肝门部位胆管癌手术切除的诊疗分析.胃肠病学和肝病学杂志, 2018, 27(7):804-807.
11周宁新,黄志强,张文智,等. 402例肝门部胆管癌临床分型、手术方式及远期疗效的综合分析.中华外科杂志, 2006, 44(23):1599-1603.
12中国医师协会外科医师分会胆道外科医师委员会.胆道手术加速康复外科专家共识(2016版).中华消化外科杂志, 2017, 16(1):6-13.
13Park MJ, Kim YK, Lim S, et al. Hilar cholangiocarcinoma:value of adding DW imaging to gadoxetic acid-enhanced MR imaging with MR cholangiopancreatography for preoperative evaluation.Radiology, 2014, 270(3):768-776.
14中国抗癌协会.肝门部胆管癌规范化诊治专家共识(2015).中华肝胆外科杂志, 2015, 21(8):505-511.
15黄华明,赵平.肝门部胆管癌手术切除范围的研究进展与争议.中华肝胆外科杂志, 2018, 24(1):67-70.
165Noji T, Tsuchikawa T, Okamura K, et al. Surgical outcome of hilar plate resection:extended hilar bile duct resection without hepatectomy. J Gastrointest Surg, 2014, 18(6):1131-1137.
17张辉,王孟龙.单中心56例肝门部胆管癌的外科治疗.中华肝胆外科杂志, 2017, 23(1):16-19.
18鲁敏,秦兴雷,蔡建平,等. 89例肝门部胆管癌术后并发症分析.中华普通外科学杂志, 2015, 30(7):535-537.
19杜羽升,赵文星,王骥,等.完全腹腔镜手术治疗肝门部胆管癌(附6例报道).中国普外基础与临床, 2017, 24(12):1487-1491.