干旱区生态环境知识资源中心(Arid): 小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验

Arid

	小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验
其他题名	Minor liver resection for hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ
	李恩山 1; 孙延雷 1; 刘学键 2; 邰庆拚 1; 赵荣飞 1; 吕士放 1; 陈孝平 3
来源期刊	中华外科杂志
ISSN	0529-5815
出版年	2019
卷号	57 期号:7 页码:523-526
中文摘要	目的探讨小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床效果及安全性。方法回顾性分析2007年5月至2017年5月在临沂市肿瘤医院肝胆外科接受手术切除的108例Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者资料,其中男性56例,女性52例,年龄(57.25.3)岁(范围:48~76岁)。Ⅲa型51例,Ⅲb型40例,Ⅳ型17例。小范围肝切除(≤3个肝段切除)70例:肝脏4b段切除8例,4b段+ 5段切除28例,部分4段+部分7段切除+部分1段切除34例。大范围肝切除38例(>3个肝段):肝脏2段+3段+4段+1段切除30例,5段+7段+8段+1段切除8例。不符合正态分布的计量资料采用t’检验进行统计学分析,对术后并发症发生率及1、3、5年累积总体生存率的统计采用chi~2检验。结果(1)小范围肝切除组与大范围肝切除组相比,手术时间短[(18025)min比(210 35)min] (t ’ =4.676,P<0.05),术中出血量少[(31080)ml比(500110)ml] (t ’ =9.385,P<0.05)。(2)小范围组与大范围组相比术后并发症发生率低(chi~2=5.230,P<0.05)。(3)小范围肝切除和大范围肝切除术后1、3、5年累积总体生存率分别为87.1%、58.4%、30.0%和84.2%、57.9%、31.6%,两组相比较无明显差异(chi~2 =0.177, P=0.674; chi~2 =0.005,P=0.946; chi~2 =0.029, P=0.865)。结论小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌疗效确切,陈氏肝肠吻合法简单、安全、有效,可以广泛推广使用。
英文摘要	Objective To explore the clinical effect and safety of minor liver resection for hilar cholangiocarcinoma(HC) of Bismuth-Corlette type Ⅲ and Ⅳ. Methods From May 2007 to May 2017,the clinical data of 108 patients with Bismuth-Corlette type Ⅲ and Ⅳ HC underwent hepatectomy were collected and analyzed retrospectively. There were 56 males and 52 females, aged (57.25.3)years(ranged 48 - 76 years). Among the 108 cases, there were 51 cases of type Ⅲ a,40 oases of type Ⅲ b and 17 cases of type Ⅳ. Small-scale hepatectomy(≤3 hepatectomy) was performed in 70 cases, including 8 cases of 4b segment resection, 28 cases of 4b segment+5 segment resection,and 34 cases of partial 4 segment+partial 7 segment+partial 1 segment resection. Large-scale hepatectomy was performed in 38 cases(>3 segments),of which 30 cases were treated with 2 segments+3 segments+4 segments +1 segment, and 8 cases were treated with 5 segments + 7 segments + 8 segments + 1 segment, t’ test was used to analyze the data which did not conform to the normal distribution, and chi~2 test was used to calculate the incidence of postoperative complications and the 1, 3,and 5-year cumulative overall survival rate. Results (1) The operation time of minor liver resection group ((18025)minutes) was shorter than that of major liver resection group ((210 35)minutes) (t’=4.676,P<0.05),the amount of blooding operation time of minor liver resection group ((310 80)ml) was less than that of major liver resection group ((500110)ml)in the operation(t’=9.385,P<0.05),and the difference was statistically significant. (2)The incidence of complications was lower in minor liver resection group and major liver resection group, and the difference was statistically significant(chi~2=5.230,P< 0.05). (3) The actual 1-,3- and 5-year survival rates were 87.1%, 58.4%,30.0% and 84.2%,57.9%,31.6%, respectively. There were no significant differences in survival rates in two groups in 1-,3- and 5-year survival rates(chi~2 =0.177,P=0.674; chi~2 =0.005,P=0.946; chi~2 =0.029,P=0.865). Conclusions Compared to patients with major liver resection, Minor liver resection for selected patients with HC of Bismuth-Corlette Ⅲ and IV according to our criteria achieved better long-term outcomes. Chen’s biliojejunostomy is a simple,effective and safe method,which can be widely used when there are multiple biliary intestinal anastomosese.
中文关键词	胆道肿瘤 ; 肝切除术 ; 治疗
英文关键词	Biliary tract neoplasms Hepatectomy Therapy
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:6528595
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/239848
作者单位	1.临沂市肿瘤医院肝胆外科, 临沂, 山东 276001, 中国; 2.临沂经济开发区人民医院肿瘤中心, 临沂, 山东 276023, 中国; 3.华中科技大学同济医学院附属同济医院肝脏外科中心, 武汉, 湖北 430030, 中国
推荐引用方式 GB/T 7714	李恩山,孙延雷,刘学键,等. 小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验[J],2019,57(7):523-526.
APA	李恩山.,孙延雷.,刘学键.,邰庆拚.,赵荣飞.,...&陈孝平.(2019).小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验.中华外科杂志,57(7),523-526.
MLA	李恩山,et al."小范围肝切除治疗Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的临床经验".中华外科杂志 57.7(2019):523-526.