摘要
目的:总结转化治疗联合腔镜根治性肝切除手术治疗晚期胆道恶性肿瘤的临床效果及优势。方法:回顾性分析2022年10月在南京大学医学院附属鼓楼医院普外科肝胆胰中心一例转化治疗后行解剖性肝右后切除＋区域淋巴结清扫手术的晚期胆道恶性肿瘤患者的临床资料。结果:患者(肝内胆管细胞癌伴右侧肾上腺侵犯、肝门部、后腹膜及锁骨上淋巴结转移Ⅳ期)接受术前GC方案联合化学药物治疗四个周期＋度伐利尤单抗免疫治疗两个周期后成功降期(肝内胆管细胞癌伴右侧肾上腺侵犯、肝门部、后腹膜淋巴结转移ⅢB期)，行腔镜根治性肝切除手术，术中出血量少，术后无感染、出血、胆瘘等。术后2个月复查肿瘤标志物及相关影像学检查未见明显异常。结论:运用转化治疗理念，结合Laennec入路微创腔镜技术，提高病理缓解率及手术切除率，从而有望改善晚期胆道恶性肿瘤患者的长期预后。
Abstract
Object:To summarize the feasibility and advantages of using radical surgery under laparoscopy in a patient with advanced biliary tract cancer underwent conversion therapy.Methods:A retrospective analysis of the clinical data about a patient underwent this novel procedure in the Hepatobiliary and Pancreatic Center of the Department of General Surgery, Affiliated Drum Tower Hospital, Medicine School of Nanjing University in Oct. 2022.Results:The patient with advanced biliary tract cancer underwent conversion therapy, whose tumor was successfully downstaged, and received radical surgery. Less intraoperative bleeding, no postoperative infection, bleeding, biliary fistula and so on. Tumor markers and related imaging examinations showed no abnormalities 2 months after surgery.Conclusions:It is expected to improve the long-term prognosis of patients with advanced biliary malignancies by applying the concept of conversion therapy combined with Laennec approach minimally invasive endoscopy to enhance the pathological remission rate and surgical resection rate.
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