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目的观察肝动脉切除重建在肝门部胆管癌治疗中的价值。方法1998年1月至2005年12月计收治125例肝门部胆管癌,其中行肝动脉切除13例,对该资料进行分析。结果在行肝动脉切除13例中,同时合并门静脉切除重建3例,其中部分肝固有动脉+右或左肝动脉切除联合左或右半肝及尾状叶切除10例,局部切除联合肝固有动脉切除1例,部分肝固有动脉+右或左肝动脉切除联合扩大左或右半肝及尾状叶切除各1例,肝动脉切除后未重建2例。术后胆肠吻合口漏4例,围手术期肝功能衰竭死亡1例,其余12例病人术后随访4个月至6年,平均20个月,其中最长的1例已存活5年5个月。结论肝动脉切除重建可提高肝门部胆管癌的治愈切除率,改善术后病人预后;肝脏大部切除联合肝动脉切除在中、重度黄疸病人须重建动脉血供。
Objective To observe the value of hepatic artery resection and reconstruction in the treatment of hilar cholangiocarcinoma. Methods From January 1998 to December 2005, 125 cases of hilar cholangiocarcinoma were enrolled, of which 13 cases underwent hepatic artery resection. The data were analyzed. Results Of the 13 cases undergoing hepatic artery resection, 3 cases were simultaneously resected by portal vein resection. Some of them were excised with right or left hepatic artery and 10 cases with left or right hemiliver and caudate lobectomy. Local resection combined with hepatic artery One case was resected. One part of the hepatic artery plus right or left hepatic artery resection combined with enlarged left or right hepatic and caudate lobe resection was performed in 1 case. Two cases were not reconstructed after hepatic artery resection. 4 cases died of choledochojejunostomy, 1 died of perioperative hepatic failure, and the remaining 12 cases were followed up for 4 months to 6 years, with an average of 20 months. The longest of them survived for 5 years 5 Months. Conclusions Hepatic artery resection and reconstruction can improve the curative resection rate of hilar cholangiocarcinoma and improve the prognosis of postoperative patients. Subtotal hepatectomy combined with hepatic artery resection requires reconstruction of arterial blood supply in patients with moderate and severe jaundice.