Cheng Yu, Chen Yuxin, Chen Hongqiang
Department of Hepatic-Biliary Surgery, Qilu Hospital, Shandong University, Ji'nan, China.
Am Surg. 2010 Feb;76(2):182-7.
For the surgical treatment of Bismuth Type IV hilar cholangiocarcinoma, it is difficult to achieve curative resection (R0 resection) with restrictive excision (local resection and parenchyma-preserving liver resection) as a result of the complexity and difficulty in biliary reconstruction. Extended hepatectomy with vessel resection can improve the rate of curative resection, but it can also give rise to postoperative complications and mortality. We proposed a high hilar resection and portal parenchyma-enterostomy method to improve the surgical procedure. Eleven patients with Bismuth IV hilar cholangiocarcinoma underwent high hilar resection (resection for tumors in bile ducts and 1 cm above the tumors including segments IVb, V, and part of the caudate liver lobe) and the biliary tract was reconstructed through a portal parenchyma-enterostomy. Biliary radicles were not ligated but were drained into the "bile lake." No cases of perioperative death were observed. Four weeks after surgery, patients' serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin were decreased evidently. The average survival was 25.3 months. In conclusion, the portal parenchyma-enterostomy procedure can be performed with increased curative rate and reduced parenchyma resection, extending the survival time of patients and improving patients' quality of life.
对于Bismuth IV型肝门部胆管癌的外科治疗，由于胆管重建的复杂性和困难，采用限制性切除（局部切除和保留肝实质的肝切除术）难以实现根治性切除（R0切除）。行血管切除的扩大肝切除术可提高根治性切除率，但也会导致术后并发症和死亡率增加。我们提出了一种高位肝门切除和门静脉实质-肠吻合术来改进手术方法。11例Bismuth IV型肝门部胆管癌患者接受了高位肝门切除（切除胆管肿瘤及肿瘤上方1 cm范围，包括IVb段、V段和部分尾状叶肝组织），并通过门静脉实质-肠吻合术重建胆道。未结扎胆管分支，而是将其引流至“胆湖”。未观察到围手术期死亡病例。术后4周，患者血清天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素明显下降。平均生存期为25.3个月。总之，门静脉实质-肠吻合术可提高根治率，减少肝实质切除，延长患者生存时间，提高患者生活质量。
