探讨全腹腔镜Ⅳ型肝门部胆管癌根治术的可行性及临床应用价值。

回顾性分析2015年4月至2015年12月在湖南省人民医院行腹腔镜Ⅳ型肝门部胆管癌根治术2例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。例1男，73岁，因"皮肤巩膜黄染1个月余"入院。例2女，62岁，因"皮肤巩膜黄染2个月余"入院。入院诊断均为Ⅳ型肝门部胆管癌。2例患者肿瘤均侵犯至双侧肝管及门静脉左支。术前给予以护肝、退黄等对症支持治疗，行全腹腔镜肝门部胆管癌根治术。由远及近清扫淋巴结，离断胆总管，切除左半肝及尾状叶，肝门胆管整形，Roux-en-Y胆肠吻合。

2例均顺利完成手术，并重建消化道。手术时间分别为430、410 min，术中出血量分别为800、600 ml。无发生围手术期并发症。2例患者术后1年复查腹部增强CT，均未发现复发及转移。

全腹腔镜Ⅳ型肝门部胆管癌根治术安全可行，可以完成包括尾状叶在内的半肝或扩大半肝切除、淋巴结清扫、胆管整形、胆肠吻合重建。

To explore the feasibility and clinical application value of total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma.

Clinical data of 2 patients receiving total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma in Hunan Provincial People's Hospital from April 2015 to December 2015 were analyzed retrospectively. The informed consents of both patients were obtained and the local ethical committee approval was received. Case 1, male, 73 years old, hospitalized for icteric skin and sclera for more than 1 month. Case 2, female, 62 years old, hospitalized for icteric skin and sclera for more than 2 months. The admitting diagnosis were both Ⅳ-type hilar choangiocarcinoma. The bilateral hepatic ducts and left portal vein were invaded by tumor in the 2 cases. Before the operation, the patients received symptomatic and supportive treatments for liver protection, jaundice alleviation etc., and then received total laparoscopic radical resection of hilar choangiocarcinoma. The lymph nodes were resected from far to near, the common bile duct was dissected and cut off, the left and caudate lobe was resected, hilar bile duct plasty and Roux-en-Y bilioenterostomy were performed.

Operations were performed successfully in both patients and the digestive tract was reconstructed. The operative duration were 430, 410 min respectively, the intraoperative blood loss was 800, 600 ml respectively. No perioperative complication was observed. Two patients received abdominal enhanced CT examination 1 year after operation, no tumor recurrence or metastasis was observed.

Total laparoscopic radical resection of hilar choangiocarcinoma is safe and feasible, in which hemihepatectomy or extended hemihepatectomy including caudate lobe, lymphadenectomy, bile duct plasty and biliary-enteric reconstruction can be performed.