Combined caudate lobectomy radical resection and lymph node dissection for hilar cholangiocarcinoma
10.3670.cma.j.issn.1007-631X.2019.12.001
- VernacularTitle:肝门部胆管癌手术切除方式选择和淋巴结清扫的临床应用分析
- Author:
Zhedong ZHANG
1
;
Dafang ZHANG
;
Wenyong XIE
;
Weihua ZHU
;
Jiye ZHU
;
Xisheng LENG
;
Shu LI
Author Information
1. 北京大学人民医院肝胆外科 100044
- Keywords:
Bile duct neoplasms;
Lymph node excision;
Comparative effectiveness research
- From:
Chinese Journal of General Surgery
2019;34(12):1017-1020
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy and prognostic factors for combined caudate lobectomy radical resection plus broad lymph node dissection in patients of hilar cholangiocarcinoma.Methods The clinical data and follow-up results of patients with hilar cholangiocarcinoma surgically treated from Feb 2008 to Feb 2017 were retrospectively analyzed.Result The R0 resection rate[72.2％ (13/18) vs 43.9％ (18/41)],operation time [(433 ± 136) min vs (302 ± 122) min],intraoperative blood loss [(1 789 ± 1 091) ml vs (776 ± 755) ml] and postoperative complication rate [66.7％ (12/18) vs 36.6％ (15/41)]were significantly higher in the hepatic lobe combined with caudate lobe resection group than that without caudate lobe resection group (P ＜ 0.05).The median survival time of patients with enlarged lymph node dissection was longer than that of patients with regional lymph node dissection (33 months vs 13 months,P ＜0.05).Univariate and multivariate analysis showed that the preoperative serum CA199 level ＞ 1 000 U/ml,the degree of microscopic margin and tumor TNM stage were significantly correlated with the prognosis of the patients (P ＜ 0.05).Conclusion Combined with caudate lobe resection can improve R0 resection rate.Targeted lymph node dissection helps prolong survival.The degree of microscopic margin,preoperative CA199 and TNM staging are independent risk factors for the prognosis of patients with hilar cholangiocarcinoma.
