Hepatoligamentectomy for perihilar cholangiocarcinoma

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  • 肝門部胆管癌に対する肝切除兼肝十二指腸間膜一括切除
  • リンショウ ケイケン カンモンブタンカン ガン ニ タイスル カン セツジョ ケン カン ジュウニシチョウ カンマク イッカツ セツジョ

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We present four cases with perihilar cholangiocarcionoma complicated by portal vein and hepatic artery invasion. The patients underwent hepatoligamentectomy.<BR>The mean age was 60 ; there were two men and two women. Three patients underwent an expanded left hepatectomy, and one patient underwent an expanded right hepatectomy. One patient underwent pancreatoduodenectomy during the same surgery. All portal veins were reconstructed using a right femoral vein graft. The mean operative time was 532 minutes and the mean blood loss was 1,240 ml. The mean reconstruction time was 23 minutes for the portal vein and 23 minutes for the hepatic artery. Although two patients had postoperative complications (groin bleeding and hyperbilirubinemia) all patients were discharged from hospital after surgery. Two patients died due to cancer two years after the operation. Two patients are alive with no recurrence (51 months and 14 months). Patency of all reconstructed vessels was confirmed after discharge from hospital.<BR>The portal vein was reconstructed using a continuous suture ; the hepatic artery was formed into a spatula shape using a slit and was then reconstructed via the parachute technique.<BR>A general surgeon should be able to safely reconstruct the portal vein or the hepatic artery.

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