[1]陈德兴,曹春和,徐刚,等.腹腔镜上段胆管癌根治切除术[J].中国微创外科杂志,2008,08(1):31-34.
　Chen Dexing,Cao Chunhe,Xu Gang,et al.Laparoscopic Cholangiotomy for Radical Excision of Upper Cholangiocarcinoma[J].Chinese Journal of Minimally Invasive Surgery,2008,08(1):31-34.
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腹腔镜上段胆管癌根治切除术()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年1期
页码:
31-34
栏目:
出版日期:
2008-10-22

文章信息/Info

Title:
Laparoscopic Cholangiotomy for Radical Excision of Upper Cholangiocarcinoma
作者:
陈德兴; 曹春和; 徐刚; 李佳和; 李健; 王伟; 朱刚
吉林省前卫医院普外科，长春130012
Author(s):
Chen Dexing;  Cao Chunhe;  Xu Gang;  et al.
Department of General Surgery, Qianwei Hospital, Changchun 130012, China
关键词:
腹腔镜; 上段胆管癌; 根治术
Keywords:
Laparoscopy; Upper cholangiocarcinoma; Radical excision
分类号:
R735.8
文献标志码:
A
摘要:
目的探讨腹腔镜上段胆管癌根治切除术的可行性。方法分别于脐部、 右侧上、下腹部及剑突下放置trocar，左上腹部3 cm切口用于空肠端侧吻合。切除胆囊及肝左内叶下段的肝组织，切除中上段胆管，肝侧胆管距肿瘤1 cm切断。清除肝固有动脉、门静脉周围的纤维脂肪组织及淋巴结。左、右肝管盆式成形，胆肠RouxenY吻合。结果４例胆管肿瘤上端均已达到肝管分叉部，肿瘤直径1～1.５ cm。左内叶下段肝组织、中上段胆管的切除及肝门区淋巴结清扫顺利。４例腹腔镜上段胆管癌根治切除手术均获成功。手术时间分别为270、255、270、230 min；术中出血量分别为500、400、300、400 ml。4例术后病理均为高分化腺癌。例2、3术后出现胆漏，分别于术后20、15 d治愈。4例黄疸于术后完全消退，食欲恢复正常，体重分别增加3、35、22 kg。结论应用腹腔镜微创技术可以完成上段胆管癌根治切除时所需切除的胆管肿瘤，部分肝组织，清扫肝门区纤维脂肪组织及淋巴结，腹腔镜下完成胆道重建。腹腔镜上段胆管癌根治切除术是可行的。
Abstract:
ObjectiveTo evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma.MethodsFour trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for RouxenY jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middleupper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bilejejunum RouxenY anastomosis was performed. ResultsThe hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively.ConclusionsUpper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.

参考文献/References:

[1]黄志强，主编.当代胆道外科学.第1版.上海: 上海科学技术出版社，1998.615-616.
[2]黄洁夫,主编.腹部外科学.第1版 .北京:人民卫生出版社, 2001.1438-1443.
[3]陈德兴 , 董加纯 , 赵淑清,等.腹腔镜下RouxenY肝 管空肠吻合术在胆道疾病治疗中的临床应用.中华肝胆外科杂志,2005，（9）:73-74.
[4]刘荣, 胡明根, 赵向前,等 . 完全腹腔镜肝切除的临床应用价值（附123例经验总结）.腹腔镜外科杂志，2006,6:34-36.
[5]蔡秀军,虞洪,郑雪勇,等.腹腔镜右半肝切除一例.中华医学杂志，2005，（13）:9-10.
[6]Belli G, Fantini C, D’Agostino A, et al. Laparoscopic left lateral hepatic lobectomy: a safer and faster technique. Hepatobiliary Pancreat Surg,2006,13(2): 149-154.

更新日期/Last Update: 2013-10-22