Surgical management of hilar cholangiocarcinoma
Surgical management of hilar cholangiocarcinoma
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DOI：
10.1097/01.sla.0000160701.38945.82
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发表时间：
2005-05-01
影响因子：
9
通讯作者：
Howard, RJ
中科院分区：
文献类型：
--
作者：
Hemming, AW;Reed, AI;Howard, RJ
目的：评估肝门部胆管癌的手术治疗在一段时间内，肝切除被认为是标准的management.Summary背景资料：肝门部胆管癌仍然是一个困难的挑战，外科医生。手术治疗的一个进步是在手术中增加了肝切除。然而，肝切除术的设置引起的肝功能不全的胆道梗阻mortality.Methods：在1997年和2004年之间，80例肝门部胆管癌手术进行了审查。53例患者9例尝试了根治性切除术，14例患者进行了姑息性旁路手术，而13例患者的发现排除了任何进一步的干预。23例患者需要门静脉切除和重建，以实现阴性边缘，其中3例还需要重建肝动脉。结果：接受切除的患者有9%的手术，死亡率，与发病率为40%。术前因对侧肝脏肿瘤累及或门静脉栓塞（PVE）诱导而表现出肺叶肥大的患者的手术死亡率显著低于无肥大的患者。切除患者的中位总生存期为40个月，5年生存率为35%。在80%的病例中实现了阴性切缘，并与生存率的提高相关。结论：肝门部胆管癌行肝、胆管联合切除术，死亡率可接受，但仍高于其他适应证的肝切除术。在术前未发生残肝肥大的病例中使用PVE可降低手术死亡率。
Objective: To assess the Surgical management of hilar cholangiocarcinoma over a time period when liver resection was considered standard management.Summary Background Data: Hilar cholangiocarcinoma remains a difficult challenge for surgeons. An advance in surgical treatment is the addition of liver resection to the procedure. However, liver resection in the setting of liver dysfunction caused by biliary obstruction can be associated with increased mortality.Methods: Between 1997 and 2004, 80 patients with hilar cholangiocarcinoma having surgery were reviewed. Fifty-three patients 9 had attempted curative resections, 14 patients had palliative bypasses, while 13 patients had findings that precluded any further intervention. Twenty-three patients required portal vein resection and reconstruction to achieve negative margins, 3 of which also required reconstruction of the hepatic artery.Results: Patients undergoing resection had a 9% operative ,mortality, with morbidity of 40%. Patients who demonstrated lobar hypertrophy preoperatively due to tumor involvement of the contralateral liver or induced with portal vein embolization (PVE) had a significantly lower operative mortality than those patients without hypertrophy. Median overall survival in patients resected was 40 months, with 5-year survival of 35%. Negative margins were achieved in 80% of cases and were associated with improved survival. Five-year Survival in patients undergoing resection with negative mar-ins was 45%.Conclusion: Combined liver and bile-duct resection can be performed for hilar cholangiocarcinoma with acceptable mortality, though higher than that for liver resections performed for other indications. The use of PVE in cases where hypertrophy of the remnant liver has not occurred preoperatively may reduce the risk of operative mortality.