肝门部胆管癌手术治疗34例临床分析

Surgical treatment of hilar cholangiocarcinoma: A clinical analysis of 34 cases

目的探讨肝门部胆管癌的诊断、手术方式的选择及其疗效.方法回顾性总结分析1994年1月～2004年7月手术治疗的肝门部胆管癌34例的临床资料.结果34例中手术切除22例(64.1%),根治性切除15例(44.1%),姑息性切除7例;内、外引流12例.围手术期死亡9例(26.5%).出院25例中获得随访21例(84%),平均生存9.6个月.根治性切除10例,平均生存16.1个月,现仍存活6例,分别为5、7、16、24、26、32个月.姑息性切除和引流11例,平均生存5个月,无1年生存者.结论早期诊断和根治性切除是肝门部胆管癌获得根治的唯一途径.选择合理的术式,提高手术技巧和加强围手术期的处理是提高手术疗效的重要措施.

Objective To evaluate the diagnosis and surgical treatment of hilar cholangiocarcinoma （H-CC）. Methods Clinical data of 34 patients with H-CC treated surgically in our hospital from Jan. 1994 to Jul. 2004 were analyzed retrospectively. Results Of the 34 patients, 22 underwent resection （64. 1%）, 15 radical resection （44. 1%） and 7 palliative resection. Twelve cases were subjected to internal or external drainage. Nine cases died perioperatively （26. 5%）. Of the 25 cases discharged, 21 were fallowed up （84%）. The mean survival time was 9.6 months. In 10 cases subject to radical resection, the mean survival time was 16. 1 months and among them, 6 survived （with the survival time being 5, 7, 16, 24, 26 and 32 months respectively）. In 11 cases subject to palliative resection and drainage, the mean survival time was 5 months and no one survived over one year. Conclusion Early diagnosis and radical resection is still the unique choice for the treatment of H-CC. To select operative method properly, experienced operative skills and strengthen the perioperative management are important measures for improving surgical effects.