【摘要】 目的观察联合血管切除重建在肝门部胆管癌(Perihilar Cholangiocarcinoma,PHC)外科手术中的应用效果。方法将2013年8月—2015年8月我院治疗的PHC患者42例作为研究对象,将其应用随机数表法分为两组,每组各21例。观察组实施PHC根治术、肝动脉和门静脉联合切除重建术;对照组实施姑息性肿瘤切除、内引流减黄手术治疗。观察两组术中出血量、胆漏发生率、住院时间、术后死亡率等。结果较对照组中出血量(496. 74±235. 81) m L、手术时间(341. 25±98. 71) min相比,观察组术中出血量(763. 91±309. 24) m L相对较多,手术时间(439. 14±92. 05) min相对较长,差异有统计学意义(P <0. 05);两组住院时间(18. 95±4. 07) d、(19. 67±4. 89) d,并发症总发生率(47. 62%、57. 14%)、手术期生存率(90. 48%、100. 00%)对比,差异无统计学意义(P> 0. 05);较对照组1 y、2 y、3 y时生存率57. 14%、42. 86%、23. 81%相比,观察组1 y、2 y、3 y时生存率85. 71%、76. 19%、57. 14%相对较高,差异有统计学意义(P <0. 05)。结论 PHC外科手术中联合血管切除重建可提升根治性切除效果且并发症少,利于降低患者病死率,但其也存在手术难度大、风险高的弊端。更多还原

【Abstract】 Ojbective To observe the effect of combined vascular resection and reconstruction in the surgical treatment of hilar cholangiocarcinoma( PHC). Methods Forty-two PHC patients treated in our hospital from August 2013 to August 2015 were enrolled in the study,and were randomly divided into two groups,21 in each group. The observation group underwent PHC radical resection,hepatic artery and portal vein resection and reconstruction; the control group underwent palliative tumor resection and internal drainage and yellow reduction surgery. The intraoperative blood loss,the incidence of bile leakage,hospitalization time,and postoperative mortality were observed. Results Compared with the control group,the amount of blood loss( 496. 74 ± 235. 81) m L and the operation time( 341. 25 ± 98. 71) min,the intraoperative blood loss( 763. 91 ± 309. 24) m L was relatively more,and the operation time( 439. 14 ± 92. 05) min was relatively higher. Long,the difference was statistically significant( P < 0. 05); the length of hospital stay( 18. 95 ± 4. 07) d,( 19. 67 ± 4. 89) d,the total incidence of complications was 47. 62%,57. 14%,the survival rate during surgery was 90. 48%,100. 00%. The difference was not statistically significant( P > 0. 05); compared with the control group at 1 year,2 years,and 3 years,the survival rate was 57. 14%,42. 86%,23. 81%,and the observation group was 1 year,2 years,and 3 years. The survival rate was85. 71%,76. 19%,and 57. 14%,and the difference was statistically significant( P < 0. 05). Conclusion Combined vascular resection and reconstruction in PHC surgery can improve the effect of radical resection with fewer complications and reduce mortality,but it also has the disadvantages of difficult operation and high risk.更多还原