肝门部胆管癌外科治疗分析

Result of surgical therapy for hilar cholangiocarcinoma

目的 研究影响肝门部胆管癌疗效的因素。方法 回顾性分析 1997～ 2 0 0 2年收治的198例肝门部胆管癌的临床资料。结果 198例的主要临床表现为黄疽 (94 5 % ,187例 )、瘙痒(5 6 6 % ,112例 )和腹痛 (33 8% ,6 7例 )。Bismuth CorletteⅠ型 14例 ,Ⅱ型 19例 ,Ⅲa型 12例 ,Ⅲb型 15例 ,Ⅳ型 112例 ,分型不清楚者 2 6例。手术切除 12 0例 (83 3% ) ,根治性切除 5 9例 (41 0 % ) ,姑息性切除 6 1例 ,剖腹探查胆道置管引流 2 4例 ,ERCP及PTCD内外引流 5 4例。 16例术后行放射治疗。术后生存时间与职业、术前最高血清总胆红素水平、手术方式和术后放疗四个因素显著相关。ENBD、ERBD或EMBE、胆道探查置管引流、肿瘤姑息切除、根治切除不同治疗方式的术后生存时间总体差异有显著意义 (χ2 =87 0 4 89,P <0 0 1)。结论 早期诊断和根治切除是提高肝门部胆管癌疗效的重要措施。

Objective To analyze factors influcing the surgical curative effect of hilar cholangiocarcinoma. Methods A retrospective clinical analysis was made on 198 patients with hilar cholangiocarcinoma, who were surgically treated in our hospital from 1997 to 2002. Jaundice (94.5%, 187 cases), pruritus (56.6%, 112 cases) and abdominal pain (33.8%, 67 cases) were the main symptoms. According to Bismuth-Corlette classification, there were 14 type Ⅰ cases, 19 type Ⅱ cases, 12 type Ⅲa caese, 15 type Ⅲb cases, 112 type Ⅳ cases and 26 unclassifiable cases. 144 patients received laparotomy, and tumor resection was performed in 120 cases, including radical resection in 59 caese (41.0%) and palliative resection in 61 cases. 54 cases were treated by endoscopic therapy or PTCD. 16 cases received postoperative adjuvant radiation. Results Occupation, preoperative maximum tatal serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival. The postoperative survival of ENBD group, ERBD or EMBE group, biliary exploration & drainage group, palliative resection group and radical resction group differed statistically as a whole (χ2= 87.048?9, P<0.01). Conclusion Early diagnosis and radical resection are important to improve the prognosis of hilar cholangiocarcinoma.