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目的探讨肝门部胆管癌和尾状叶肝管结石术中对尾状叶的外科治疗方式。方法选取我院2007年8月-2008年8月收治的42例肝门部胆管癌和尾状叶肝管结石患者,在手术后对其进行观察,回顾分析患者的临床资料。并比较不同的手术方式。结果 42例患者均实行手术治疗。手术方式包括肝门部肿瘤及尾状叶联合左半肝切除18例;行肝门部肿瘤及尾状叶切除6例;右侧尾状叶切除3例;尾状叶胆管开口切开整形加探查取石6例;其中3例附加左半肝切除,3例附加残余肝左内叶切除。肝内胆管及尾状叶胆管取石,左右肝管切开,空肠Roux-Y内引流术9例。无手术死亡。其中18例肝门部肿瘤及尾状叶联合左半肝切除的患者中10例存活超过2年,8例超过3年。结论肝门部胆管癌和尾状叶肝管结石的根治范围应该包括肝尾状叶的切除;尾状叶肝管结石应切开左右肝管,力争在术中可以取尽所有的结石。
Objective To investigate the surgical treatment of caudate lobe in hilar cholangiocarcinoma and caudate lobectomy. Methods Forty-two patients with hilar cholangiocarcinoma and caudate lobe hepatic duct stones admitted from August 2007 to August 2008 in our hospital were selected and observed after operation. The clinical data of the patients were retrospectively analyzed. And compare different surgical methods. Results 42 patients underwent surgical treatment. Surgical methods included hilar tumors and caudate lobectomy in 18 cases with left hepatic resection; hepatic hilar tumors and caudate lobe resection in 6 cases; right caudate lobectomy in 3 cases; caudate lobe biliary duct incision and plastic surgery Exploration of stone in 6 cases; 3 cases with additional left hemihepatectomy, 3 cases of residual left hepatic lobe resection. Intrahepatic biliary and caudate leaf bile duct stone, left and right hepatectomy, jejunum Roux-Y drainage in 9 cases. No surgery died. Of the 18 patients with hilar tumors and caudate lobectomy, 10 survived more than 2 years and 8 had more than 3 years. Conclusions The radical treatment of hilar cholangiocarcinoma and caudate lobe tuberculosis should include resection of the caudate lobe lobes. The caudate lobectomy hepatic duct stones should be dissected around the hepatic duct so that all the stones can be removed during operation.