Liu Sulai, Liu Xinyu, Li Xuepeng, Li Ou, Yi Weimin, Khan Junaid, Yang Pingzhou, Guo Chao, Peng Chuang, Jiang Bo
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, 410005 Hunan Province, China.
Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, 410005 Hunan Province, China.
Gastroenterol Res Pract. 2020 Feb 25;2020:1506275. doi: 10.1155/2020/1506275. eCollection 2020.
This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C).
Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded.
Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence.
Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.
本研究旨在探讨腹腔镜根治性切除术治疗Ⅲ型和Ⅳ型肝门部胆管癌（Ⅲ/Ⅳ型肝门部胆管癌）的可行性和安全性。
我院纳入6例Ⅲ/Ⅳ型肝门部胆管癌患者。所有患者均接受全腹腔镜手术，包括基础手术（腹腔镜胆囊、肝门部胆管、胆总管切除及肝十二指肠韧带淋巴结清扫）联合左肝及尾状叶切除/门静脉切除。观察肿瘤大小、手术时间、术中出血量及术后并发症。记录患者出院后的随访情况。
6例患者手术均顺利完成。发现6例患者肿瘤大小为1.5至3.6厘米，有4个淋巴结。手术时间为540 - 660分钟，出血量为300 - 500毫升。1例患者术后发生胆漏，引流后2周内愈合。术后住院时间为16（13 - 24）天。胆管切缘肿瘤阴性4例，阳性1例，1例未报告。6例患者均顺利出院，无围手术期死亡。出院后每3个月进行定期检查，中位持续时间为7个月。仅1例患者有边缘发育异常，5例患者无明显复发迹象。
对于Ⅲ/Ⅳ型肝门部胆管癌，在进行充分的术前评估、恰当的病例选择及精确的手术策略下，应用腹腔镜根治性切除术是安全可行的，且具有良好的短期疗效。
