肝门部胆管癌的诊断与外科治疗

Diagnosis and surgical treatment of hilar cholangiocarcinoma

目的探讨肝门部胆管癌的诊断方法与外科治疗效果。方法对1996年1月～2006年1月间我院收治的肝门部胆管癌56例的临床诊疗资料及随访结果进行回顾性总结分析。结果B超及磁共振(MR)对肝门部胆管癌56例的定位及定性诊断率分别为91.1%和100%。56例均行手术治疗,其中探查术5例,内、外引流术23例,均于术后2～15个月死亡;切除术28例,手术切除率50.0%;行根治性切除24例(3例联合肝动脉重建),中位生存期为29个月;姑息性切除4例,中位生存期为12个月。结论应用B超和MR等多种影像技术对肝门部胆管癌的定位及定性诊断符合率高,能较准确地评估肝门部胆管癌的手术切除可能性。根治切除是改善肝门部胆管癌疗效的重要措施。

Objective To investigate the diagnosis and effectiveness of surgical treatment in hilar cholangiocarcinoma.Methods The clinical features,diagnosis,surgical therapy and long-term outcome were retrospectively analyzed in 56 cases of hilar cholangiocarcinoma from January 1996 to January 2006.Results Fifty-six patients with hilar cholangiocarcinoma were diagnosed by imaging of B-type ultrasound and MR examinations.The diagnosis accuracy rate was 100%.All 56 cases were subjected to surgical treatment.Twenty-three cases treated by internal or external drainage had survived for 2~15 months.Tumor resection was performed in 28 cases,with a resection rate of 50.0% including radical resection in 24 cases(three of them were subjected to radical resection in combined with hepatic artery reconstruction),and the median survival time was 29 months.Four cases undergoing palliative resection had a median survival period of 12 months.Conclusion MR multi-imaging techniques have high accuracy in the diagnosis of the location and nature of hilar cholangiocarcinoma,and can evaluate accurately the feasibility of resection in patients with hilar cholangiocarcinoma.Radical resection definitely prolongs survival period for the patients.