One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality
One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality
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DOI：
10.1097/01.sla.0000217605.66519.38
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发表时间：
2006-08-01
影响因子：
9
通讯作者：
Kosuge, Tomoo
中科院分区：
文献类型：
--
作者：
Sano, Tsuyoshi;Shimada, Kazuaki;Kosuge, Tomoo
目的：分析近5年来肝门周围胆管癌行肝胆切除术的近期手术结果。背景资料：肝门周围胆管癌行肝胆切除术仍是一项技术要求高的手术，需要高水平的胆道和肝脏外科专业知识，且仍与显著的发病率或死亡率相关。在2000年至2004年期间，我们手术治疗了102例肝门周围胆管癌患者，其治疗策略包括术前胆道引流、门静脉栓塞（右侧和扩大左侧切除）和主要肝胆切除。对所有患者的资料进行回顾性分析，以确定可能显着影响术后死亡率和发病率的因素。严重并发症7例（6.9%），总发病率为50%。2例患者（2%）需要再次手术。术后住院时间的总体中位数为26天（范围，13-119天）。单因素分析显示术前节段性胆管炎或胆囊炎的发生率（P = 0.015）、术后高胆红素血症的严重程度（P < 0.001）和新鲜冰冻血浆的使用量（P = 0.002）与术后并发症的发生率有显著性差异。多变量分析揭示了术后发病率的一个独立显著预测因素，即术前胆管炎或胆囊炎结论：我们的经验表明，肝门周围胆管癌的肝胆切除术可以安全地进行，没有一例术后肝功能衰竭或死亡。术前胆管炎或胆囊炎的发生是肝胆大切除术并发症的重要指标。
Objective: To analyze the short-term surgical outcome of hepatobiliary resections for perihilar cholangiocarcinoma in the last 5 years.Summary Background Data: Hepatobiliary resection for perihilar cholangiocarcinoma remains a technically demanding procedure, calling for a high level of expertise in biliary and hepatic surgery, and is still associated with significant morbidity or mortality.Methods: Between 2000 and 2004, we surgically treated 102 consecutive patients with perihilar cholangiocarcinoma with a management strategy consisting of preoperative biliary drainage, portal vein embolization (for right-sided and extended left-sided resections), and major hepatobiliary resection. The data on all of the patients were analyzed retrospectively to identify the factors that might significantly affect the postoperative mortality and morbidity.Results: There were no cases of in-hospital mortality or postoperative liver failure. Major complications were encountered in 7 patients (6.9%), and the overall morbidity rate was 50%. Reoperation was required in 2 patients (2%). The overall median length of postoperative hospital stay was 26 days (range, 13-119 days). Univariate analysis in relation to the postoperative morbidity showed significant differences in the preoperative occurrence of segmental cholangitis or cholecystitis (P = 0.015), the severity of postoperative hyperbilirubinemia (P < 0.001), and the total amount of fresh frozen plasma administered (P = 0.002). Multivariate analysis revealed a single independent significant predictive factor for postoperative morbidity, namely, preoperative cholangitis or cholecystitis (odds ratio, 9.08; 95% confidence interval, 1.05-78.56, P = 0.045).Conclusions: Our experience indicates that hepatobiliary resections for perihilar cholangiocarcinoma can be conducted safely, without a single case of postoperative liver failure or mortality. Occurrence of preoperative cholangitis or cholecystitis is a significant indicator for morbidity of major hepatobiliary resection.