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目的总结肝叶切除联合门静脉切除和重建在肝门部胆管癌中应用的临床经验。方法回顾分析1998年至2003年收治118例肝门部胆管癌患者的临床资料。结果 118例中66例实施了姑息性治疗;52例实施根治性切除手术,其中联合肝切除者47例,肝切除中11例实施了联合门静脉切除和重建。行肝切除者术后并发症发生率为22.9%,合并门静脉切除者为27.3%;1、3年的存活率仅行肝切除者和合并门静脉切除者分别为85.7%、31.4%和81.8%、27.8%,2组差异无统计学意义。姑息治疗组仅5例存活超过3年(7.58%),无5年生存者。结论门静脉浸润不是肝门部胆管癌手术的禁忌证,肝叶切除联合门静脉切除和重建提高其治愈切除率,改善术后患者的预后。
Objective To summarize the clinical experience of hepatectomy combined with portal vein resection and reconstruction in hilar cholangiocarcinoma. Methods The clinical data of 118 patients with hilar cholangiocarcinoma admitted to our hospital from 1998 to 2003 were retrospectively analyzed. Results Of the 118 cases, 66 cases were treated with palliative treatment. In 52 cases, radical resection was performed, of which 47 cases were treated with hepatectomy and 11 cases were resected and reconstructed with hepatectomy. The incidence of postoperative complications in patients underwent hepatectomy was 22.9% with 27.3% of patients with portal vein resection. The survival rates of 1, 3-year and 55% of patients with hepatic resection and portal vein resection were 85.7%, 31.4% and 81.8% 27.8%, there was no significant difference between the two groups. Only 5 patients in the palliative group survived more than 3 years (7.58%) and had no 5-year survivors. Conclusions Portal vein infiltration is not a contraindication to hilar cholangiocarcinoma surgery. Hepatectomy combined with portal vein resection and reconstruction improves its curative resection rate and improves postoperative prognosis.