Noji Takehiro, Tsuchikawa Takahiro, Okamura Keisuke, Nakamura Toru, Tamoto Eiji, Shichinohe Toshiaki, Hirano Satoshi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan,
J Gastrointest Surg. 2015 Apr;19(4):675-81. doi: 10.1007/s11605-015-2754-y. Epub 2015 Feb 4.
The clinical impact of concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma remains unclear. Microvascular anastomosis is typically used for arterial reconstruction, but we have proposed arterioportal shunting (APS) as an alternative procedure. The aims of this retrospective study were to evaluate concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma patients, to evaluate the safety and survival impact of APS, and to evaluate whether APS offers a good alternative to microvascular reconstruction.
Thirty-nine patients with perihilar cholangiocarcinoma who required arterial reconstructions were retrospectively evaluated.
No significant difference was seen in overall incidence of postoperative complications between groups, but the incidence of liver abscess formation was significantly higher in the APS group. The cumulative 5-year survival rate was 15% in patients undergoing concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma. No significant differences in survival were identified between the microvascular (MV) and APS groups. Cumulative 5-year survival rates were 18% in the MV group and 11% in the APS group.
Concomitant arterial resection and reconstruction are feasible for patients with perihilar cholangiocarcinoma. Microvascular reconstruction should be used as the first-line strategy for these patients, with APS indicated only when the artery is unable to be microscopically anastomosed.
肝门部胆管癌同期动脉切除与重建的临床影响尚不清楚。微血管吻合术通常用于动脉重建，但我们提出了动门脉分流术（APS）作为一种替代方法。这项回顾性研究的目的是评估肝门部胆管癌患者的同期动脉切除与重建，评估APS的安全性和对生存的影响，并评估APS是否是微血管重建的良好替代方法。
对39例需要动脉重建的肝门部胆管癌患者进行回顾性评估。
两组术后并发症的总体发生率无显著差异，但APS组肝脓肿形成的发生率显著更高。肝门部胆管癌同期动脉切除与重建患者的5年累积生存率为15%。微血管（MV）组和APS组在生存方面无显著差异。MV组的5年累积生存率为18%，APS组为11%。
肝门部胆管癌患者同期动脉切除与重建是可行的。微血管重建应作为这些患者的一线策略，仅在动脉无法进行显微吻合时才考虑使用APS。
