He Xiao-dong, Liu Wei, Tao Lian-yuan, Zhang Zhen-huan, Cai Lei, Zhang Shuang-min
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Zhong Liu Za Zhi. 2009 Aug;31(8):626-9.
To evaluate the surgical technique of "Kou mode of hepatic hilar anastomosis" in the treatment for type III or IV hilar cholangiocarcinoma.
The clinical data of 89 patients with type III or IV hilar cholangiocarcinoma surgically treated in our department between Jan. 1990 and Jan. 2008 were retrospectively analyzed. Since January 2000, "Kou mode of hepatic hilar anastomosis" was performed for some patients with advanced hilar cholangiocarcinoma. The patients were divided into two groups: group A treated between 1990 and 1999, group B between 2000 and 2008. The rate of resection, therapeutic efficacy and complications in these two groups were compared, respectively.
Of the 37 cases with hilar cholangiocarcinoma in group A, 4 were surgically treated (10.8%), with 1 (2.7%) radical resection and 3 (8.1%) palliative resection. Among the 52 cases with hilar cholangiocarcinoma in the group B, 35 (67.3%) received surgical resection, of them 15 (28.8%) underwent radical resection and 20 (38.5%) had palliative resection. Twenty-eight of these 35 cases underwent the "Kou mode of hepatic hilar anastomosis". The resection rate of advanced hilar cholangiocarcinoma in the group B was significantly higher than that in group A (P < 0.05). The complications in the 89 cases included ascites (3 cases), hemobilia (1 case), heart failure (1 case), and wound infection (2 cases). All the patients who were treated with the "Kou mode of hepatic hilar anastomosis" developed bile leakage to a varying degree and recovered after drainage and symptomatic treatment.
The resection rate of type III or IV advanced hilar cholangiocarcinoma can be remarkably improved by using a novel alternative surgical technique called "Kou mode of hepatic hilar anastomosis". However, the long-term outcome still needs to be determined by close follow-up and further observation.
评估“寇氏肝门部吻合术式”治疗Ⅲ型或Ⅳ型肝门部胆管癌的手术技术。
回顾性分析1990年1月至2008年1月在我科手术治疗的89例Ⅲ型或Ⅳ型肝门部胆管癌患者的临床资料。自2000年1月起，对部分晚期肝门部胆管癌患者采用“寇氏肝门部吻合术式”。将患者分为两组：A组为1990年至1999年治疗的患者，B组为2000年至2008年治疗的患者。分别比较两组的切除率、治疗效果及并发症。
A组37例肝门部胆管癌患者中，4例接受手术治疗（10.8%），其中根治性切除1例（2.7%），姑息性切除3例（8.1%）。B组52例肝门部胆管癌患者中，35例（67.3%）接受手术切除，其中根治性切除15例（28.8%），姑息性切除20例（38.5%）。这35例患者中有28例行“寇氏肝门部吻合术式”。B组晚期肝门部胆管癌的切除率明显高于A组（P < 0.05）。89例患者的并发症包括腹水（3例）、胆道出血（1例）、心力衰竭（1例）和伤口感染（2例）。所有采用“寇氏肝门部吻合术式”治疗的患者均出现不同程度的胆漏，经引流及对症治疗后恢复。
采用一种名为“寇氏肝门部吻合术式”的新型替代手术技术可显著提高Ⅲ型或Ⅳ型晚期肝门部胆管癌的切除率。然而，长期疗效仍需通过密切随访和进一步观察来确定。
