【摘要】 目的探讨重度梗阻性黄疸患者广泛肝切除手术的安全性。方法回顾性分析2000年至今连续21例重度梗阻性黄疸患者术前检查结果、术后并发症及恢复情况。患者平均血清胆红素为341.05μmol/L(191.3~641.6μmol/L)。21例均为肝门胆管癌,1例合并肝内胆管结石。术前均不减黄。切肝方式包括左半肝切除14例,其中2例切除受累肝固有动脉未做动脉重建,1例切除部分门静脉并重建,左半肝加左尾状叶切除4例,右半肝切除1例,扩大右半肝切除1例,右三叶加全尾状叶并门静脉部分切除重建1例。结果手术治愈率95.2%,术后30 d内死亡率4.8%(1/21),术后并发症发生率90.5%(19/21),术后肝功衰发生率4.8%(1/21)但逆转,其余并发症有胆瘘(28.6%)、腹腔感染(19.0%)、腹水(38.1%)、切口并发症(9.5%)、心衰(9.5%)、胸腔积液(4.8%)等。28.6%(6/21)需带腹腔引流管出院。结论重度梗阻性黄疸患者如一般情况较好、无严重合并症,不作术前减黄仍能耐受较大量肝切除。术后死亡率在可接受范围,但并发症发生率高。更多还原

【Abstract】 Objective To study safety of major hepatectomy in hilar cholangiocarcinoma complicated with heavily obstructive jaundice.Methods Laboratory examination results postoperative complications,and dischanrging status in consecutive 21 heavily obstructive jaundiced patients who underwent major hepatectomy since 2000 up to now were analyzed retrospectively.The mean serum total bilirubin level was 341.05 μmol/L(ranged from 191.3 μmol/L to 641.6 μmol/L).Except concomitant biliary stones being found in 1 patient,all 21 cases suffered from hilar cholangiocarcinoma.No preoperative biliary drainage wad given.The hepatic resection styles included left hepatectomy(n=14),2 of which received proper hepatic artery resection without reconstruction and 1 received portal vein reconstruction(n=1),left hepatectomy plus left caudate lobectomy(n=4),right hepatectomy(n=1),extend right hepatectomy(n=1),left hepatectomy plus left caudate lobectomy(n=4),right hepatectomy(n=1),extend right hepatectomy(n=1),extend right hepatectomy(n=1),right trisegmentectomy plus total caudated lobectomy and partial portal vein resection(n=1).Blood loss was between 400 ml to plus total caudate lobectomy and partial portal vein resection(n=1).Blood loss was between 400 ml to 2 000 ml.Results The curative and 30 d mortality rates were 95.2%(20/21) and 4.8%(1/21) respectively,which overall in-hospital morbidity was 90.5%(19/21).Postoperative complications included acute liver failure(4.8%),bile leakage(28.6%).abdominal infection(19.0%),wound problems(9.5%),cardiac failure(9.5%),and pleural effusion(4.8%).6 patients(28.6%) were discharged with temporary abdominal drainage.Conclusions Patients suffered from heavily obstructive jaundice could still tolerage major hepatic resection well if they had good general conditions and no serous concomitant disease.The mortality rate was acceptable,While postoperative morbidity being very high.更多还原