兰州大学机构库 >学院待认领
肝门部胆管癌的外科治疗
Alternative TitleSurgical treatment of Hilar cholangiocarcinoma
王春芳
Thesis Advisor曹农
2011-12-06
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword肝门部胆管癌 外科治疗
Abstract目的:探讨肝门部胆管癌的诊断和外科治疗,加深对该疾病的认识。 方法:回顾分析35例经手术治疗的肝门部胆管癌患者的临床资料。纳入标准为:术前影像学诊断为肝门部胆管癌或术前诊断为梗阻性黄疸经手术探查诊断为肝门部胆管癌。其中男23例,女12例,男女比例1.9:1,年龄36-79岁,平均57岁。所有患者均无严重心、肺、肾伴发疾病。Bismuth-CorletteⅠ型17例,Ⅱ型5例,Ⅲa型1例,Ⅲb型4例,Ⅳ型7例,分型不清楚者1例。其中联合各类肝叶切除7例(肝门部肝组织楔形切除3例,肝左叶切除+尾状叶切除2例,肝左叶切除1例,联合肝右叶及门静脉左支楔形切除1例),局部切除(肝外胆道切除)22例,其中根治性切除8例,姑息性切除14例,姑息性引流3例,单纯探查手术3例。 结果: 29例获得病理资料。其中高分化腺癌9例,中分化腺癌15例,低分化腺癌2例,未分化癌1例,黏液腺癌2例;手术后肝功能化验指标较术前有了明显改善;术后发生并发症6例,发生率17.1%,其中胆漏3例,术后出血1例、切口感染1例、死亡1例,除死亡病例外其余经支持治疗2 -3周治愈。本组病例术后平均住院时间24d,超过30d者8例。死亡病例为Bismuth-CorletteⅣ型患者,行剖腹探查手术,肿瘤无法切除,内引流及外引流手术亦无法完成,术后1天死亡,死亡原因为肝功能衰竭至多器官功能衰竭。 结论: 1、提高对肝门部胆管癌认识和警惕,对梗阻性黄疸的患者应先行B 超检查筛选,然后联合MRCP 或CT,即可基本明确肝门部胆管癌诊断及判断肿瘤可切除性。 2、对肝门部胆管癌手术治疗应抱有积极态度,联合肝切除可提高根治性切除率,根治性效果明显好于姑息性切除,对于不能切除患者可采用姑息性引流术。术后患者肝功能可获得明显改善。 3、妥善预防和处理手术并发症可提高肝门部胆管癌患者的生存率和治疗效果。
Other AbstractObjective : To discuss the diagnosis and surgical treatment of Hilar Cholangiocarci- noma and further inhance the understanding of this disease. Methods: The diagnostic criterion of Hilar Cholangiocarcinoma was imaging diagnosis before operation or made a definite diagnosis by exploratory operation but diagnosed as the jaundice block before operation. Including 23 males, 12 females, the rate was 1.9:1, 36-79 years old, the mean age was 57 years old. No patients complained of serious cardial, pulmonary and nephric pathological changes. All of these patients included Bismuth-Corlette type Ⅰin 17 cases, type Ⅱin 5 cases, type Ⅲa in 1 case, type Ⅲb in 4 cases, type Ⅳ in 7 cases and no Bismuth-Corlette type in 1 case. All the patients acquired resections, amoing which 7 had hepatectomy combined with ( 3 had wedgeshaped resected the tissue at the hepatic portal, 2 had resected the left and caudate lobe, 1 had resected the left lobe,1 had wedgeshaped resected the right lobe and the left branch of portal veins ), 25 had local resected ( extrahepatic bile duct resection), 10 were radical excision and 15 were palliation, 3 had palliative external drainage, 3 had laparotomy. Results : 29 patients which were acquired the pathological records were diagnosed as adenocarcinoma, among which 9 were of high differentiation, 15 were of low differentiation, 1 was of undifferentiation, 2 were of mucinous adenocarcinoma; the assay index of liver function showed great improvement after operation. Complication took place in 6 cases ( 17.1%), of which 3 cases with bile leakage, 1 case with hemorrhage, 1 case with wound infection, 1 case died. All the patients were cured after 2-3 weeks treatment except the case of death. The median length of hospital stay was 24 days after operation, 8 cases were more than 30 days. The case which Hilar Cholangiocarcinoma can not be cut and internal and external drainage can not be accomplished died of multiple organ failure caused by hepatic failure in 1 day after surgial explorated was Bismuth-Corlette type Ⅳ. Conclusion: 1 To enhance the understanding and redouble our vigilance of Hilar Cholangiocarcinoma, the patients with obstructive jaundice should be examined by B-ultrasund, then combined with MRCP or CT, we can define the diagnosis and evaluation for resectability of Hilar Cholangiocarcinoma. 2 we should have a positive attitude towards the operation of Hilar Cholangiocarcinoma, hepatectomy combined with could improve the radica...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223481
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
王春芳. 肝门部胆管癌的外科治疗[D]. 兰州. 兰州大学,2011.
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