Combined Hepatic Lobes Partial Resection In The Treatment Of Hepatic Hilar Cholangiocarcinoma Application

Objective: Discussion union liver leaf partial excision in treatment liver gate department bile duct cancer's application value.Methods:Review of January 1, 2002 to March 2009 in our hospital diagnosed as hilar cholangiocarcinoma, and partial resection of the joint lobe of 28 patients with clinical data.Results:Simply combined caudate lobe resection in 2 cases, a simple combined left liver resection in 11 cases, simple joint right lobe liver resection in 5 cases, left lobe combined with total caudate lobe resection in 4 cases, left lobe combined left caudate lobe resection of one case , right half of the liver combined with all of the caudate lobe resection in 2, left inner lobe resection in 2 cases, left hepatectomy combined with all of the caudate lobe and pancreatoduodenectomy in 1 case, all cases were hepatoduodenal bone based cleaning, high bile duct resection, resection underwent left or right hepatic in bile duct jejunum Roux-en-Y type choledochojejunostomy. All the patients CCP effective follow-up 21 cases, follow-up rate of 75%, follow-up time (2.12 -61.06) months to observe the end point for the deaths, lost, or this study final follow-up time. Causes of death were cancer recurrence and metastasis. 28 cases of cumulative survival rate of 1,2,3 years, respectively (71±0.1)%, (48±0.12)%, (24±0.11)%, median survival time was (20.09±4.162) months. The whole group R0 radical 18 cases, an effective follow-up in 14 cases, the cumulative survival rate of 1,2,3 years, respectively (78±0.11)%, (59±0.14)%, (36±0.16)%, in which survival period (26.14±4.584) months. R1 and R2 radical total of 10 cases, an effective follow-up in 8 cases, the cumulative survival rate of 1,2,3 years, respectively (60±0.18)%, (26±0.18)%, 0%, in which median survival time was (13.03±2.409) months, of which R1 + R2 radical group no more than 3 years survival, in consideration of R1, R2 group number of cases is small not significant, so the R1 and R2, and a group discussion. Postoperative survival curves were significantly different (X2 = 4.978, P <0.05 Figure 2) to the Kaplan-Meier method, survival rates for statistics, survival data were analyzed by log-rank test, P <0.05 to have significantly different , there were statistically significant. The patients in the R0 radical group and R1 + R2 radical group comparison, R0 radical resection group, survival rate was significantly higher than the R1 + R2 group, with the postoperative survival time, the separation of the increasing tendency.Conclusion:(1) According to the imaging in the preoperative can give Bismuth classification, and the initial development of individualized surgical plan, but since imaging to error, the specific classification and surgical treatment should be confirmed after exploratory surgery and correction.(2) R0 curative resection help prolong survival.(3) For liver function and general status of patients to allow liver resection help to improve the cure rate of hilar cholangiocarcinoma. (4) Combined right half liver resection prone to more complications, should be careful for a combined right half liver resection, combined left half liver resection is relatively safe.