6例完全3D腹腔鏡下肝門部膽管癌根治術圍手術期治療效果總結_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

劉養歲 ,  崔龍 , 李歡送 , 李正臣 , 倪忠鵬 , 齊敦峰 , 張軍

徐州市中心醫院肝膽胰中心（江蘇徐州 221009）;

Corresponding?author：

崔龍, Email: lboclong@aliyun.com

Keywords：

肝門部膽管癌; 完全3D腹腔鏡; 根治術; 療效

DOI：

10.7507/1007-9424.202212057

Video：

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目的總結完全3D腹腔鏡下肝門部膽管癌根治術圍手術期的臨床療效。方法回顧性收集2021年10月至2022年9月期間在徐州市中心醫院行完全3D腹腔鏡下肝門部膽管癌根治術的6例患者的臨床資料并分析總結，其中 Bismuth分型Ⅰ型2例，Ⅲa型2例，Ⅲb型1例，Ⅳ型1例。結果 6例患者均成功完成了3D腹腔鏡下肝門部膽管癌根治術，中位手術時間為490 min（360～600 min），中位術中出血量為550 mL（200～800 mL），中位術后首次排氣時間為2 d（2～3 d），中位術后拔除引流管時間為7 d（5～8 d），中位術后住院時間為12.5 d（10～20 d）。術后病理報告均為膽管腺癌，切緣均為陰性；中位淋巴結清掃數為11枚（6～14枚）；術后有1例患者（Ⅳ型）出現膽汁漏，經保守治療7 d后痊愈；1例患者術后出現胃癱，給予保守治療30 d后好轉；其余患者無術后并發癥發生。患者術后規律隨訪2～14個月，中位隨訪時間7.5個月，均生存良好，均未見腫瘤復發和轉移。結論在嚴格選擇病例情況下，由經驗豐富的腹腔鏡外科醫師行完全3D腹腔鏡下肝門部膽管癌根治術是安全、可行的，近期效果良好，值得進一步探討。

Citation： 劉養歲, 崔龍, 李歡送, 李正臣, 倪忠鵬, 齊敦峰, 張軍. 6例完全3D腹腔鏡下肝門部膽管癌根治術圍手術期治療效果總結. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(5): 603-607. doi: 10.7507/1007-9424.202212057 Copy

1.	Nooijen LE, Swijnenburg RJ, Klümpen HJ, et al. Surgical therapy for perihilar cholangiocarcinoma: state of the art. Visc Med, 2021, 37(1): 18-25.
2.	胡雅菲, 胡海潔, 李富宇. 擴大根治術在肝門部膽管癌中的應用. 中國普外基礎與臨床雜志, 2022, 29(12): 1554-1558.
3.	Rassam F, Roos E, van Lienden KP, et al. Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience. Langenbecks Arch Surg, 2018, 403(3): 289-307.
4.	李佳隆, 邵英梅. 肝門部膽管癌外科治療的現狀與展望. 中國普外基礎與臨床雜志, 2022, 29(11): 1528-1533.
5.	郝志強, 季德剛, 孟子輝, 等. 肝門部膽管癌不同治療方法的療效. 中華肝膽外科雜志, 2017, 23(8): 517-520.
6.	尹新民, 劉雅玲, 成偉, 等. 全腹腔鏡Ⅳ型肝門部膽管癌根治術的臨床應用價值(附視頻). 中華肝臟外科手術學電子雜志, 2018, 7(2): 110-114.
7.	Li J, Xiong Y, Yang G, et al. Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center. Wideochir Inne Tech Maloinwazyjne, 2021, 16(1): 62-75.
8.	朱宇瀟, 王驥, 馬紅欽, 等. 完全腹腔鏡下肝門部膽管癌根治術14例經驗總結. 中國普外基礎與臨床雜志, 2019, 26(1): 56-60.
9.	袁俊建, 王振勇, 李鳳山, 等. 全腹腔鏡下肝門部膽管癌根治術30例分析. 中華普通外科雜志, 2019, 34(6): 523-526.
10.	李德宇, 陶連元, 潘玉進, 等. 腹腔鏡肝門部膽管癌根治術的臨床療效. 中華消化外科雜志, 2020, 19(5): 519-524.
11.	徐建, 熊永福, 黃徐建, 等. 腹腔鏡肝門部膽管癌根治性切除近期療效的多中心臨床研究. 中華外科雜志, 2020, 58(10): 758-764.
12.	Wang Z, Liang J, Chen J, et al. Three-dimensional (3D) laparoscopy versus two-dimensional (2D) laparoscopy: a single-surgeon prospective randomized comparative study. Asian Pac J Cancer Prev, 2020, 21(10): 2883-2887.
13.	Zwimpfer TA, Lacher D, Fellmann-Fischer B, et al. A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students. BMC Surg, 2020, 20(1): 276. doi: 10.1186/s12893-020-00892-8.
14.	Sakata S, Grove PM, Hill A, et al. Impact of simulated three-dimensional perception on precision of depth judgements, technical performance and perceived workload in laparoscopy. Br J Surg, 2017, 104(8): 1097-1106.
15.	Dirie NI, Wang Q, Wang S. Two-dimensional versus three-dimensional laparoscopic systems in urology: a systematic review and meta-analysis. J Endourol, 2018, 32(9): 781-790.
16.	Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
17.	Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
18.	Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery, 2011, 149(5): 713-724.
19.	Han YG, Song T, Kang H, et al. Incidence and severity of visually induced motion sickness during 3D laparoscopy in operators who had no experience with it (VISION). Wideochir Inne Tech Maloinwazyjne, 2020, 15(2): 283-289.
20.	Pantalos G, Patsouras D, Spartalis E, et al. Three-dimensional versus two-dimensional laparoscopic surgery for colorectal cancer: systematic review and meta-analysis. In Vivo, 2020, 34(1): 11-21.
21.	Chen L, Li B, Zeng L, et al. Three-dimensional vs 2-dimensional laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(49): e18222. doi: 10.1097/MD.0000000000018222.
22.	李倉, 俞世安, 吳曉康, 等. 3D腹腔鏡BismuthⅣ型肝門部膽管癌根治術. 中華普通外科雜志, 2021, 36(7): 553-555.
23.	Chaudhary RJ, Higuchi R, Nagino M, et al. Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2 778 cases. J Hepatobiliary Pancreat Sci, 2019, 26(11): 490-502.
24.	Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
25.	葉正陳, 陳曉星, 王琳. 可手術切除的肝門部膽管癌術前膽道引流治療爭議. 中國普外基礎與臨床雜志, 2020, 27(6): 763-767.
26.	Chen GF, Yu WD, Wang JR, et al. The methods of preoperative biliary drainage for resectable hilar cholangiocarcinoma patients: A protocol for systematic review and meta analysis. Medicine (Baltimore), 2020, 99(21): e20237. doi: 10.1097/MD.0000000000020237.
27.	Mocan T, Horhat A, Mois E, et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J Gastrointest Oncol, 2021, 13(12): 2050-2063.
28.	Andert A, Bruners P, Heidenhain C, et al. Impact of preoperative three-dimensional computed tomography cholangiography on postoperative resection margin status in patients operated due to hilar cholangiocarcinoma. Gastroenterol Res Pract, 2017, 2017: 1947023. doi: 10.1155/2017/1947023.
29.	Li X, Duan R, He Y, et al. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population. Front Surg, 2022, 9: 934183. doi: 10.3389/fsurg.2022.934183.
30.	Kuriyama N, Isaji S, Tanemura A, et al. Transhepatic hilar approach for perihilar cholangiocarcinoma: significance of early judgment of resectability and safe vascular reconstruction. J Gastrointest Surg, 2017, 21(3): 590-599.
31.	Kambakamba P, Linecker M, Slankamenac K, et al. Lymph node dissection in resectable perihilar cholangiocarcinoma: a systematic review. Am J Surg, 2015, 210(4): 694-701.
32.	Bagante F, Tran T, Spolverato G, et al. Perihilar cholangiocarcinoma: number of nodes examined and optimal lymph node prognostic scheme. J Am Coll Surg, 2016, 222(5): 750-759.
33.	Hakeem AR, Marangoni G, Chapman SJ, et al. Does the extent of lymphadenectomy, number of lymph nodes, positive lymph node ratio and neutrophil-lymphocyte ratio impact surgical outcome of perihilar cholangiocarcinoma? Eur J Gastroenterol Hepatol, 2014, 26(9): 1047-1054.
34.	徐建, 張薇, 鄔長康, 等. 腹腔鏡下根治性切除術治療Ⅳ型肝門部膽管癌的效果分析. 臨床肝膽病雜志, 2019, 35(3): 565-569.
35.	Li QJ, Zhou ZG, Lin XJ, et al. Clinical practice of basin-shaped hepaticojejunostomy following hilar resection of stage Ⅲ/Ⅳ hilar cholangiocarcinoma. BMC Gastroenterol, 2019, 19(1): 99. doi: 10.1186/s12876-019-1012-2.
36.	Song Y, Zhang Y, Zhen Z, et al. Effects of portal vein resection and hepatic artery resection on long-term survival in Klatskin tumor: a meta-analysis. World J Surg Oncol, 2022, 20(1): 230. doi: 10.1186/s12957-022-02692-1.
37.	徐光勛, 葉晟, 項燦宏, 等. 復雜肝門部膽管癌手術中的肝動脈重建技術. 中國普外基礎與臨床雜志, 2022, 29(10): 1273-1278.

1. Nooijen LE, Swijnenburg RJ, Klümpen HJ, et al. Surgical therapy for perihilar cholangiocarcinoma: state of the art. Visc Med, 2021, 37(1): 18-25.
2. 胡雅菲, 胡海潔, 李富宇. 擴大根治術在肝門部膽管癌中的應用. 中國普外基礎與臨床雜志, 2022, 29(12): 1554-1558.
3. Rassam F, Roos E, van Lienden KP, et al. Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience. Langenbecks Arch Surg, 2018, 403(3): 289-307.
4. 李佳隆, 邵英梅. 肝門部膽管癌外科治療的現狀與展望. 中國普外基礎與臨床雜志, 2022, 29(11): 1528-1533.
5. 郝志強, 季德剛, 孟子輝, 等. 肝門部膽管癌不同治療方法的療效. 中華肝膽外科雜志, 2017, 23(8): 517-520.
6. 尹新民, 劉雅玲, 成偉, 等. 全腹腔鏡Ⅳ型肝門部膽管癌根治術的臨床應用價值(附視頻). 中華肝臟外科手術學電子雜志, 2018, 7(2): 110-114.
7. Li J, Xiong Y, Yang G, et al. Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center. Wideochir Inne Tech Maloinwazyjne, 2021, 16(1): 62-75.
8. 朱宇瀟, 王驥, 馬紅欽, 等. 完全腹腔鏡下肝門部膽管癌根治術14例經驗總結. 中國普外基礎與臨床雜志, 2019, 26(1): 56-60.
9. 袁俊建, 王振勇, 李鳳山, 等. 全腹腔鏡下肝門部膽管癌根治術30例分析. 中華普通外科雜志, 2019, 34(6): 523-526.
10. 李德宇, 陶連元, 潘玉進, 等. 腹腔鏡肝門部膽管癌根治術的臨床療效. 中華消化外科雜志, 2020, 19(5): 519-524.
11. 徐建, 熊永福, 黃徐建, 等. 腹腔鏡肝門部膽管癌根治性切除近期療效的多中心臨床研究. 中華外科雜志, 2020, 58(10): 758-764.
12. Wang Z, Liang J, Chen J, et al. Three-dimensional (3D) laparoscopy versus two-dimensional (2D) laparoscopy: a single-surgeon prospective randomized comparative study. Asian Pac J Cancer Prev, 2020, 21(10): 2883-2887.
13. Zwimpfer TA, Lacher D, Fellmann-Fischer B, et al. A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students. BMC Surg, 2020, 20(1): 276. doi: 10.1186/s12893-020-00892-8.
14. Sakata S, Grove PM, Hill A, et al. Impact of simulated three-dimensional perception on precision of depth judgements, technical performance and perceived workload in laparoscopy. Br J Surg, 2017, 104(8): 1097-1106.
15. Dirie NI, Wang Q, Wang S. Two-dimensional versus three-dimensional laparoscopic systems in urology: a systematic review and meta-analysis. J Endourol, 2018, 32(9): 781-790.
16. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
17. Rahbari NN, Garden OJ, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford), 2011, 13(8): 528-535.
18. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery, 2011, 149(5): 713-724.
19. Han YG, Song T, Kang H, et al. Incidence and severity of visually induced motion sickness during 3D laparoscopy in operators who had no experience with it (VISION). Wideochir Inne Tech Maloinwazyjne, 2020, 15(2): 283-289.
20. Pantalos G, Patsouras D, Spartalis E, et al. Three-dimensional versus two-dimensional laparoscopic surgery for colorectal cancer: systematic review and meta-analysis. In Vivo, 2020, 34(1): 11-21.
21. Chen L, Li B, Zeng L, et al. Three-dimensional vs 2-dimensional laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(49): e18222. doi: 10.1097/MD.0000000000018222.
22. 李倉, 俞世安, 吳曉康, 等. 3D腹腔鏡BismuthⅣ型肝門部膽管癌根治術. 中華普通外科雜志, 2021, 36(7): 553-555.
23. Chaudhary RJ, Higuchi R, Nagino M, et al. Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2 778 cases. J Hepatobiliary Pancreat Sci, 2019, 26(11): 490-502.
24. Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology, 2018, 288(1): 7-13.
25. 葉正陳, 陳曉星, 王琳. 可手術切除的肝門部膽管癌術前膽道引流治療爭議. 中國普外基礎與臨床雜志, 2020, 27(6): 763-767.
26. Chen GF, Yu WD, Wang JR, et al. The methods of preoperative biliary drainage for resectable hilar cholangiocarcinoma patients: A protocol for systematic review and meta analysis. Medicine (Baltimore), 2020, 99(21): e20237. doi: 10.1097/MD.0000000000020237.
27. Mocan T, Horhat A, Mois E, et al. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J Gastrointest Oncol, 2021, 13(12): 2050-2063.
28. Andert A, Bruners P, Heidenhain C, et al. Impact of preoperative three-dimensional computed tomography cholangiography on postoperative resection margin status in patients operated due to hilar cholangiocarcinoma. Gastroenterol Res Pract, 2017, 2017: 1947023. doi: 10.1155/2017/1947023.
29. Li X, Duan R, He Y, et al. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population. Front Surg, 2022, 9: 934183. doi: 10.3389/fsurg.2022.934183.
30. Kuriyama N, Isaji S, Tanemura A, et al. Transhepatic hilar approach for perihilar cholangiocarcinoma: significance of early judgment of resectability and safe vascular reconstruction. J Gastrointest Surg, 2017, 21(3): 590-599.
31. Kambakamba P, Linecker M, Slankamenac K, et al. Lymph node dissection in resectable perihilar cholangiocarcinoma: a systematic review. Am J Surg, 2015, 210(4): 694-701.
32. Bagante F, Tran T, Spolverato G, et al. Perihilar cholangiocarcinoma: number of nodes examined and optimal lymph node prognostic scheme. J Am Coll Surg, 2016, 222(5): 750-759.
33. Hakeem AR, Marangoni G, Chapman SJ, et al. Does the extent of lymphadenectomy, number of lymph nodes, positive lymph node ratio and neutrophil-lymphocyte ratio impact surgical outcome of perihilar cholangiocarcinoma? Eur J Gastroenterol Hepatol, 2014, 26(9): 1047-1054.
34. 徐建, 張薇, 鄔長康, 等. 腹腔鏡下根治性切除術治療Ⅳ型肝門部膽管癌的效果分析. 臨床肝膽病雜志, 2019, 35(3): 565-569.
35. Li QJ, Zhou ZG, Lin XJ, et al. Clinical practice of basin-shaped hepaticojejunostomy following hilar resection of stage Ⅲ/Ⅳ hilar cholangiocarcinoma. BMC Gastroenterol, 2019, 19(1): 99. doi: 10.1186/s12876-019-1012-2.
36. Song Y, Zhang Y, Zhen Z, et al. Effects of portal vein resection and hepatic artery resection on long-term survival in Klatskin tumor: a meta-analysis. World J Surg Oncol, 2022, 20(1): 230. doi: 10.1186/s12957-022-02692-1.
37. 徐光勛, 葉晟, 項燦宏, 等. 復雜肝門部膽管癌手術中的肝動脈重建技術. 中國普外基礎與臨床雜志, 2022, 29(10): 1273-1278.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

6例完全3D腹腔鏡下肝門部膽管癌根治術圍手術期治療效果總結

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