Makuuchi M, Thai B L, Takayasu K, Takayama T, Kosuge T, Gunvén P, Yamazaki S, Hasegawa H, Ozaki H
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Surgery. 1990 May;107(5):521-7.
Extensive liver resection for hilar bile duct carcinoma with jaundice has high morbidity and mortality rates because of postoperative liver failure. To minimize postoperative liver dysfunction, a portal venous branch was embolized before surgery to induce atrophy of the lobe to be resected and hypertrophy of the contralateral lobe in 14 patients with hilar bile duct carcinoma. Bile was drained before surgery in 11 patients with jaundice. Portal embolization did not produce major side effects, and moderate increases of serum transaminase activity or bilirubin returned to baseline values within 1 week. Hepatectomy with bile duct resection and lymphadenectomy was performed 6 to 41 days after embolization, at which time the embolized lobe was atrophied in 12 of the patients. Extended right or left lobectomy or left trisegmentectomy (10, 3, and 1 cases, respectively) with biliointestinal reconstruction was performed. One patient with jaundice and suppurative cholangitis died 30 days after hepatectomy. Another patient died 3 months after surgery of aggravated hepatitis. After surgery, no bile leakage occurred and hyperbilirubinemia was usually moderate and reversible.
由于术后肝衰竭，对伴有黄疸的肝门部胆管癌进行广泛肝切除具有较高的发病率和死亡率。为使术后肝功能障碍降至最低，对14例肝门部胆管癌患者在手术前栓塞门静脉分支，以诱导拟切除肝叶萎缩和对侧肝叶肥大。11例黄疸患者在手术前进行了胆汁引流。门静脉栓塞未产生严重副作用，血清转氨酶活性或胆红素的中度升高在1周内恢复至基线值。在栓塞后6至41天进行肝切除联合胆管切除及淋巴结清扫，此时12例患者的栓塞肝叶已萎缩。分别进行了扩大右半肝或左半肝切除或左三叶切除（分别为10例、3例和1例）并进行胆肠重建。1例伴有黄疸和化脓性胆管炎的患者在肝切除术后30天死亡。另1例患者在手术后3个月死于重症肝炎。术后未发生胆漏，高胆红素血症通常为中度且可逆转。
