Utsumi Masashi, Sadamori Hiroshi, Shinoura Susumu, Umeda Yuzo, Yoshida Ryuichi, Nobuoka Daisuke, Takagi Kosei, Fujiwara Toshiyoshi, Yagi Takahito
Hepatogastroenterology. 2014 Nov-Dec;61(136):2167-72.
BACKGROUND/AIMS: Hepatopancreatoduodenectomy (HPD) is performed to achieve radical resection of malignant biliary tumors. We reviewed clinical outcomes to evaluate the utility of HPD in terms of morbidity and mortality.
A retrospective analysis was conducted on 17 patients underwent HPD between August 1991 and May 2013; 9 bile duct cancer, 5 advanced gallbladder and 3 pancreatic tumor with liver metastasis.
The morbidity and mortality rates were 88.3% and 0%, respectively. Univariate analysis showed that a body mass index of ≥22 and preoperative total bilirubin level ≥0.8 mg/dl were significantly associated with severe complications. One-, 3- and 5-year survival rate were 73.3%, 60.0% and 30.0%. In 14 patients with biliary carcinoma, univariate analysis showed that a histological grade of G1 was significantly associated with survival. Patients without pancreatic invasion or portal vein invasion tended to survive longer than patients with these types of invasion, although the difference was not significant.
HPD can be performed with no mortality and provides a survival benefit for some patients with biliary carcinoma undergoing curative resection. In patients with grade G1 biliary carcinoma without pancreatic or portal vein invasion in particular, this aggressive surgery might offer a chance of long-term survival.
背景/目的：进行肝胰十二指肠切除术（HPD）以实现恶性胆管肿瘤的根治性切除。我们回顾了临床结果，以评估HPD在发病率和死亡率方面的效用。
对1991年8月至2013年5月期间接受HPD的17例患者进行了回顾性分析；其中9例胆管癌，5例晚期胆囊癌和3例伴有肝转移的胰腺肿瘤。
发病率和死亡率分别为88.3%和0%。单因素分析显示，体重指数≥22以及术前总胆红素水平≥0.8mg/dl与严重并发症显著相关。1年、3年和5年生存率分别为73.3%、60.0%和30.0%。在14例胆管癌患者中，单因素分析显示G1组织学分级与生存显著相关。没有胰腺侵犯或门静脉侵犯的患者往往比有这些类型侵犯的患者存活时间更长，尽管差异不显著。
HPD可无死亡风险进行，并且为一些接受根治性切除的胆管癌患者提供生存益处。特别是对于没有胰腺或门静脉侵犯的G1级胆管癌患者，这种积极的手术可能提供长期生存的机会。
