摘要目的 探讨肝门扣式吻合术在治疗Ⅲ型和Ⅳ型肝门部胆管癌中的临床应用价值.方法 回顾性分析1990年1月至2008年1月间接受手术治疗的89例Ⅲ型和Ⅳ型肝门部胆管癌患者的临床资料.以2000年1月(开始采用肝门扣式吻合术)为界,将患者分为两个治疗阶段,比较两个阶段Ⅲ型和Ⅳ型肝门部胆管癌患者的手术切除率,并分析肝门扣式吻合术的治疗效果和并发症.结果 第一阶段治疗胆管癌患者37例,手术切除4例(10.8%),其中根治性切除1例(2.7%),姑息性切除3例(8.1%).第二阶段治疗胆管癌患者52例,手术切除35例(67.3%),其中根治性切除15例(28.8%),姑息性切除20例(38.5%).第二阶段接受手术切除治疗的35例患者中,有28例(80.0%)采用肝门扣式吻合的手术方式.统计结果 显示,无论是根治性切除还是姑息性切除,第二阶段Ⅲ型和Ⅳ型患者的手术切除率均高于第一阶段患者(均P<0.05).89例患者中,术后并发腹腔积液3例,胆道出血1例,心功能衰竭1例,伤口感染2例.采用肝门扣式吻合术的患者术后均出现不同程度的胆瘘,经引流和对症治疗后痊愈.结论 肝门扣式吻合术可提高Ⅲ型和Ⅳ型肝门部胆管癌的切除率,是一种新的可供选择的治疗方法 ,但其远期治疗效果有待进一步研究和随访.

abstractsObjective To evaluate the surgical technique of "Kou mode of hepatic hilar anastomosis" in the treatment for type Ⅲ or 1V hilar cholangiocarcinoma. Methods The clinical data of 89 patients with type Ⅲ or IV hilar cholangiocarcinoma surgically treated in our department between Jan. 1990 and Jan. 2008 were retrospectively analyzed. Since January 2000, "Kou mode of hepatic hilar anastomosis" was performed for some patients with advanced hilar cholangiocarcinoma. The patients were derided into two groups: group A treated between 1990 and 1999, group B between 2000 and 2008. The rate of resection, therapeutic efficacy and complications in these two groups were compared, respectively. Results Of the 37 cases with hilar cholangiocareinoma in group A, 4 were surgically treated ( 10.8% ), with 1 (2.7%) radical resection and 3 (8.1% ) palliative resection. Among the 52 cases with hilar cholangiocarcinoma in the group B, 35 (67.3%) received surgical resection, of them 15 (28.8%) underwent radical resection and 20 ( 38.5% ) had palliative resection. Twenty-eight of these 35 cases underwent the "Kou mode of hepatic hilar anastomosis". The resection rate of advanced hilar cholangiocarcinoma in the group B was significantly higher than that in group A ( P < 0. 05 ). The complications in the 89 cases included ascites (3 cases), hemobilia (1 case), heart failure (1 case), and wound infection (2 cases). All the patients who were treated with the "Kou mode of hepatic hilar anastomosis" developed bile leakage to a varying degree and recovered after drainage and symptomatic treatment. Conclusion The resection rate of type Ⅲ or Ⅳ advanced hilar cholangiocarcinoma can be remarkably improved by using a novet alternative surgical technique called "Kou mode of hepatic hilar anastomosis". However, the long-term outcome still needs to be determined by close follow-up and further observation.