肝门部胆管癌近年外科治疗疗效分析:附22例报告

Clinical analysis of surgical treatment for hilar cholangiocarcinoma in recent years:report of 22 cases

目的探讨肝门外胆管癌近年的诊治及临床疗效。方法回顾性分析我院2005年6月至2008年6月收治的22例肝门部胆管癌的临床资料,分析其诊治情况及预后。结果本组22例患者主要症状为进行性黄疸(19/22),术前均行MRCP检查,诊断准确率达100%,术前Bismuth Corlette分型与手术结果比较,分型准确率为86.4%。所有患者均行手术治疗,10例根治性切除,9例姑息性切除,3例胆管引流,手术切除率为86.4%(19/22);根治切除率为45.5%。术后并发症发生率为22.7%,其中腹腔感染3例,胆道感染2例,治疗后痊愈,无围手术期死亡。随访中位时间30个月,根治性切除患者术后1、3、5年生存率分别为71.3%、36.6%、25.4%,姑息切除组患者分别为54.3%、13.3%、0%,根治性切除患者生存率显著高于姑息切除患者。结论肝门部胆管癌的治疗以手术切除为主,近年来手术技术的进步,手术切除率及根治性切除率不断提高,患者预后改善。

Objective To investigate the diagnosis and surgical procedures of hilar cholangiocarcinoma,and analyze the outcomes of surgical treatment in recent years.Methods Clinical data of 22 hilar cholangiocarcinoma patients treated in our hospital from June 2005 to June 2008 were analyzed retrospectively.The outcomes of different surgical procedures were compared.Results The main clinical manifestations included progressive obstructive jaundice(19/22) and upper abdominal discomfort(16/22).The accuracy of MRCP was 100% for the diagnosis,and 86.4% for pre-operative Bismuth Corlette's types compared with laparotomy results.All the patients received surgical treatment including radical resection in 10,palliative resection in 9,only drainage procedures in 3 patients.The post-operative complication rate was 22.7% including intra-peritoneal infection in 3,biliary tract infection in 2 cases,and no peri-operative death occurred.After follow-up for a median time of 30 months,the 1,3,5-year survival rates were 71.3%,36.6% and 25.4% respectively in radical resection group,54.3%,13.3% and 0% in palliative resection group.The survival rate of the patients with radical resection was significantly higher than those with palliative resection and drainage procedures(P<0.05).Conclusions Surgical resection is the main treatment for hilar cholangiocarcinoma.In recent years,with the development of surgical techniques,the resection and radical resection rates become higher than before,and the prognosis of the patients has been improved.