肝门胆管癌手术疗效的影响因素(45例随诊分析)

The Prognostic Factors of Surgical Treatment in Hilar Cholangiocarcinoma——Follow-up Study in 45 Patients

解放军总医院肝胆外科自1986.1～1990.12间共手术治疗肝门部胆管癌45例,其中手术切除者29例,切除率为64.4％。切除组术后存活12个月者占41.4％,24个月者占20.7％;而未切除组生存未超过12个月。手术切除彻底与切缘发现残癌者愈后亦有显著差异,前者18个月仍存活者占28.6％,而后者无一例生存达18个月。术后死亡者在切除组多于6～12个月内肿瘤复发或再出现黄疸。结果显示术后残癌和复发多见于局部切除者,其病理类型与癌浸润程度之间无明显区别。提高远期疗效的关键是手术能否达到根治性切除的目的,必须充分估计沿胆管壁癌细胞浸润范围,在不超出剩余肝组织代偿能力的前提下,扩大联合肝叶切除的根治范围有可望提高远期生存率。

Between Januray, 1986 and December, 1990. Forty-five patients with hilar cholangiocarcinoma were performed operation in our department. Resection of the tumor was carried out in 29 patients. The rate of resection was 64.4％. There were no operative deaths and the survival rates were 41.4％ and 20.7％ at 12 and 24 months in the group of patients underwent tumor resection, but, the 60-day hospital mortality rate was 37.5％ and there was no survivor at 12 months in the group of patients underwent unresective operation The survival rates were significantly different between the patients performed curative resection and the patients with resective cancer margins or palliative resection. The 28％ of patients with curative resection were survival at 18 months but no one of patient with marginal carcinona was survival. Most of patients in the group of resection died from the tumor recurrence or appearance of jaundice again during 6 to 12 months. The results indicated that the remnant cancer of resective margins and tumor recurence were common in the group of patients with local or skeletization resection. There was no siginaficant difference between the type of tumor pathology and the degree of cancer invasion. We concluded that liver resection of hilar cholangiocarcinoma may give long-term survival times if a tumor free resection margin is obtained. The importance of a free resection margin indicates that surgical treatment should be made under the sufficient estimation of the tumor invasion and the extension of liver resection with the good condition of the remaining liver.