Noie T, Seyama Y, Imamura H, Kobayashi A, Miyagawa S, Kawasaki S, Makuuchi M
Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 2001 Feb;102(2):215-9.
During the past 10 years, we have performed extended right hemihepatectomy combined with pancreatoduodenectomy (rtHPD) in eight patients with bile duct carcinoma. We compared the results in these patients with those in 43 bile duct carcinoma patients who underwent extrahepatic bile duct resection with more extensive hepatectomy than hemihepatectomy. Our indication for rtHPD is bile duct carcinoma of the diffuse type involving the intrapancreatic bile duct. For patients with obstructive jaundice, biliary drainage was performed preferentially in the part of the liver to be preserved. Portal vein embolization was performed before extended right hemihepatectomy or left trisectorectomy. Complete external drainage of pancreatic juice followed by second-stage pancreatojejunostomy was performed in five rtHPD patients. There were no hospital deaths or hepatic failures. There were four 5-year survivors after rtHPD. There was no significant difference between the cumulative 5-year survival rates after rtHPD (71%) and non-HPD (42%). Patients with bile duct carcinoma whose prognosis can be improved only by rtHPD exist and should be treated by rtHPD. However, considering the reported high mortality rate after this procedure, rtHPD should not be performed in an institution where its safety cannot be guaranteed.
在过去10年里，我们对8例胆管癌患者实施了扩大右半肝切除术联合胰十二指肠切除术（rtHPD）。我们将这些患者的结果与43例接受了比半肝切除术范围更广的肝外胆管切除术的胆管癌患者的结果进行了比较。我们进行rtHPD的指征是累及胰内胆管的弥漫型胆管癌。对于梗阻性黄疸患者，优先在拟保留的肝叶进行胆管引流。在扩大右半肝切除术或左三叶切除术之前进行门静脉栓塞。5例rtHPD患者先进行胰液完全外引流，然后进行二期胰空肠吻合术。无医院死亡病例或肝衰竭发生。rtHPD术后有4例患者存活5年。rtHPD术后5年累积生存率（71%）与非HPD术后（42%）之间无显著差异。存在仅通过rtHPD才能改善预后的胆管癌患者，应接受rtHPD治疗。然而，考虑到该手术报道的高死亡率，在不能保证其安全性的机构不应进行rtHPD。
