高位胆管癌手术路径选择的应用解剖分析.docx

高位胆管癌手术路径选择的应用解剖研究
摘 要
高位胆管癌又称肝门部胆管癌(即Klatskin瘤)。是指发生在左右肝管至肝总管的恶性肿瘤。由于其解剖结构复杂,手术难度及创伤大,而且又是一极具风险的手术。如达不到根治目的,3 ,%。,手术效果更差。[目的]:为了对不同类型的胆管癌肿进行相应的根治手术或姑息胆管引流术,笔者对肝门部I一Ⅲ级胆管的解剖长度、周径进行了检测以及了解在肝脏的解剖位置,以便更好地选择各种手术入路进行手术。[方法]: 笔者收集30例正常***的肝脏标本,固定后制成镂空标本,以游标卡尺、两脚规进行测量。[结果];肝总管长约2。25±, ±;±, ±; ±,
±。左肝管较右肝管略长。可采用多种手术路径,如经肝中界面解剖路径、经肝圆韧带解剖路径、肝方叶切除解剖路径或加用尾叶切除的解剖方法,显露肝内胆管并切除肿瘤。[结论]: 目前国内外对本病的手术切除方式虽有各种探讨,但切除范围总体上有扩大趋势,只要熟悉肝门部解剖,掌握合理的手术路径, 联合肝叶或尾叶切除根治或扩大根治,是可以延长患者的生存期。
关键词:高位胆管;手术路径;解剖研究。
Research of choosing
Ol,erationPath in High-level Ⅸle Duct Carcinoma
Postgraduate Yang Changping
Directors Yang Gui j iao
(Abstract)
High—level bile duct carcinoma,which is also called portal hepatic bile duct carcinoma(namely the klatskin neoplasia),is the malignant tumor occured in from the left and right hepatic duct to COlIlmOn hepatic duct. Because of plicated anatomic structure,difficult operation and big trauma, it’S an operation with high the purpose of permanent
control can’t be reached,the 3-year surviv—al rate is only %,and the 5-year survival rate after radical operation is only %.Especially in type Bismuth
m一Ⅳbile operation effect is much
WOrse.
Objective:In order to conduct corresponding radical operation or palliatire bile duct drainage according to the bile duct carcinoma with different type,the writer detected the anatomic length and circumference of grade I—lIIbile duct in portal hepatis,prehended the anatomic position in liver,SO as to choose better various kinds of operative route to make operation.
Methods:The writer collected the 1iver specimens of 16 mon adults,which were made into hollowed-out specimens after fixation and were measured with slide
Ⅱ
gaudand passes measuring instrument.
Results:the length mon hepat ic duct is
± or so and the circumference of initiationpart is ±