6例完全3D腹腔镜下肝门部胆管癌根治术围手术期治疗效果总结_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

刘养岁 ,  崔龙 , 李欢送 , 李正臣 , 倪忠鹏 , 齐敦峰 , 张军

徐州市中心医院肝胆胰中心（江苏徐州 221009）;

Corresponding author：

崔龙, Email: lboclong@aliyun.com

Keywords：

肝门部胆管癌; 完全3D腹腔镜; 根治术; 疗效

DOI：

10.7507/1007-9424.202212057

Video：

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目的总结完全3D腹腔镜下肝门部胆管癌根治术围手术期的临床疗效。方法回顾性收集2021年10月至2022年9月期间在徐州市中心医院行完全3D腹腔镜下肝门部胆管癌根治术的6例患者的临床资料并分析总结，其中 Bismuth分型Ⅰ型2例，Ⅲa型2例，Ⅲb型1例，Ⅳ型1例。结果 6例患者均成功完成了3D腹腔镜下肝门部胆管癌根治术，中位手术时间为490 min（360～600 min），中位术中出血量为550 mL（200～800 mL），中位术后首次排气时间为2 d（2～3 d），中位术后拔除引流管时间为7 d（5～8 d），中位术后住院时间为12.5 d（10～20 d）。术后病理报告均为胆管腺癌，切缘均为阴性；中位淋巴结清扫数为11枚（6～14枚）；术后有1例患者（Ⅳ型）出现胆汁漏，经保守治疗7 d后痊愈；1例患者术后出现胃瘫，给予保守治疗30 d后好转；其余患者无术后并发症发生。患者术后规律随访2～14个月，中位随访时间7.5个月，均生存良好，均未见肿瘤复发和转移。结论在严格选择病例情况下，由经验丰富的腹腔镜外科医师行完全3D腹腔镜下肝门部胆管癌根治术是安全、可行的，近期效果良好，值得进一步探讨。

Citation： 刘养岁, 崔龙, 李欢送, 李正臣, 倪忠鹏, 齐敦峰, 张军. 6例完全3D腹腔镜下肝门部胆管癌根治术围手术期治疗效果总结. 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, 胡海洁, 李富宇. 扩大根治术在肝门部胆管癌中的应用. 中国普外基础与临床杂志, 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. 肝门部胆管癌外科治疗的现状与展望. 中国普外基础与临床杂志, 2022, 29(11): 1528-1533.
5.	郝志强, 季德刚, 孟子辉, 等. 肝门部胆管癌不同治疗方法的疗效. 中华肝胆外科杂志, 2017, 23(8): 517-520.
6.	尹新民, 刘雅玲, 成伟, 等. 全腹腔镜Ⅳ型肝门部胆管癌根治术的临床应用价值(附视频). 中华肝脏外科手术学电子杂志, 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.	朱宇潇, 王骥, 马红钦, 等. 完全腹腔镜下肝门部胆管癌根治术14例经验总结. 中国普外基础与临床杂志, 2019, 26(1): 56-60.
9.	袁俊建, 王振勇, 李凤山, 等. 全腹腔镜下肝门部胆管癌根治术30例分析. 中华普通外科杂志, 2019, 34(6): 523-526.
10.	李德宇, 陶连元, 潘玉进, 等. 腹腔镜肝门部胆管癌根治术的临床疗效. 中华消化外科杂志, 2020, 19(5): 519-524.
11.	徐建, 熊永福, 黄徐建, 等. 腹腔镜肝门部胆管癌根治性切除近期疗效的多中心临床研究. 中华外科杂志, 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.	李仓, 俞世安, 吴晓康, 等. 3D腹腔镜BismuthⅣ型肝门部胆管癌根治术. 中华普通外科杂志, 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.	叶正陈, 陈晓星, 王琳. 可手术切除的肝门部胆管癌术前胆道引流治疗争议. 中国普外基础与临床杂志, 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, 张薇, 邬长康, 等. 腹腔镜下根治性切除术治疗Ⅳ型肝门部胆管癌的效果分析. 临床肝胆病杂志, 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.	徐光勋, 叶晟, 项灿宏, 等. 复杂肝门部胆管癌手术中的肝动脉重建技术. 中国普外基础与临床杂志, 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, 胡海洁, 李富宇. 扩大根治术在肝门部胆管癌中的应用. 中国普外基础与临床杂志, 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. 肝门部胆管癌外科治疗的现状与展望. 中国普外基础与临床杂志, 2022, 29(11): 1528-1533.
5. 郝志强, 季德刚, 孟子辉, 等. 肝门部胆管癌不同治疗方法的疗效. 中华肝胆外科杂志, 2017, 23(8): 517-520.
6. 尹新民, 刘雅玲, 成伟, 等. 全腹腔镜Ⅳ型肝门部胆管癌根治术的临床应用价值(附视频). 中华肝脏外科手术学电子杂志, 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. 朱宇潇, 王骥, 马红钦, 等. 完全腹腔镜下肝门部胆管癌根治术14例经验总结. 中国普外基础与临床杂志, 2019, 26(1): 56-60.
9. 袁俊建, 王振勇, 李凤山, 等. 全腹腔镜下肝门部胆管癌根治术30例分析. 中华普通外科杂志, 2019, 34(6): 523-526.
10. 李德宇, 陶连元, 潘玉进, 等. 腹腔镜肝门部胆管癌根治术的临床疗效. 中华消化外科杂志, 2020, 19(5): 519-524.
11. 徐建, 熊永福, 黄徐建, 等. 腹腔镜肝门部胆管癌根治性切除近期疗效的多中心临床研究. 中华外科杂志, 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. 李仓, 俞世安, 吴晓康, 等. 3D腹腔镜BismuthⅣ型肝门部胆管癌根治术. 中华普通外科杂志, 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. 叶正陈, 陈晓星, 王琳. 可手术切除的肝门部胆管癌术前胆道引流治疗争议. 中国普外基础与临床杂志, 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, 张薇, 邬长康, 等. 腹腔镜下根治性切除术治疗Ⅳ型肝门部胆管癌的效果分析. 临床肝胆病杂志, 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. 徐光勋, 叶晟, 项灿宏, 等. 复杂肝门部胆管癌手术中的肝动脉重建技术. 中国普外基础与临床杂志, 2022, 29(10): 1273-1278.

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6例完全3D腹腔镜下肝门部胆管癌根治术围手术期治疗效果总结

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