Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract.
Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract.
复制标题
肝胰十二指肠切除术治疗晚期胆道癌。
作者：
Y. Nimura;N. Hayakawa;J. Kamiya;S. Maeda;S. Kondo;A. Yasui;S. Shionoya
24例晚期胆囊癌和/或胆管癌患者接受了肝胰管切除术，即整块肝切除加胰管切除术。其中胆囊癌14例，胆管癌9例，胆囊和胆管双重癌1例。对17例累及肝门的肝癌患者行11种肝叶或肝段切除加胰体切除术，并整块切除尾状叶。联合切除门静脉11例，下腔静脉2例，结肠5例。22例患者（91.7%）发生44例术后并发症。手术死亡率为12.5%（3/24）。中位生存期和2年生存率分别为7.0个月和17.9%（包括3例手术死亡），21例肝胰腺癌术后生存期和2年生存率分别为11.0个月和20.4%，14例胆囊癌术后生存期和2年生存率分别为12.4个月和20.8%。9例胆管癌术后5.2个月，14.8%。存活时间最长的患者在5年7个月时死于肿瘤复发。肝胰腺切除术不仅提供了一个意想不到的长期生存期，但在某些情况下，意想不到的发病率。
Twenty-four patients with advanced carcinoma of the gallbladder and/or the bile duct underwent hepatopancreatoduodenectomy, that is, en bloc hepatic resection with pancreatoduodenectomy. They included 14 cases of gallbladder carcinoma, nine cases of bile duct carcinoma, and one case of double cancer of the gallbladder and the bile duct. Eleven kinds of hepatic lobectomy or segmentectomy with pancreatoduodenectomy were carried out, and the caudate lobe was also removed en bloc from 17 patients with carcinoma involving the hepatic hilus. Combined resection of the portal vein was performed in 11 patients, of the inferior vena cava in 2, and of the colon in 5, patients. Forty-four postoperative complications occurred in 22 patients (91.7%). The operative mortality rate was 12.5% (3/24). The median survival and the 2-year survival rate were 7.0 months and 17.9% for all 24 patients, including 3 operative deaths, or 11.0 months and 20.4% for 21 patients surviving hepatopancreatoduodenectomy, and 12.4 months and 20.8% for all 14 patients with gallbladder carcinoma, and 5.2 months and 14.8% for all 9 patients with bile duct carcinoma. The longest survivor died of recurrent tumors at 5 years and 7 months. Hepatopancreatoduodenectomy offered not only an unexpectedly long survival period, but also unexpected morbidity in some cases.