46例肝门胆管癌的诊断和治疗

Diagnosis and cure experience of hilar cholangiocarcinomas in 46 patients

目的总结7年肝门胆管癌的外科诊断和治疗经验。方法对5年间收治的46例肝门胆管癌患者的临床表现、影像学特征、肿瘤标志物和手术方式进行分析。结果肝门胆管癌的主要临床表现为黄疸、腹痛、发热、陶土色大便、呕吐、纳差、呃逆;血清糖链抗原CA19-9的阳性率较高;B超、CT、PTC、ERCP、MRCP和肝动脉造影在影像学表现上各有其特点;治疗:5例行肝动脉灌注化疗;25例行手术治疗,其中11例行根治性切除,4例行胆管内引流术,6例行外引流术,4例行姑息性手术。术后并发症为肺部感染2例,胆道感染2例,脓毒症1例,切口感染1例,住院期间死亡3例。结论肝门胆管癌诊断应根据其临床表现、实验室检查、联合应用多种影像学和免疫组化检查进行,根治切除肝门胆管癌应做到切缘无癌残留,对不能切除的患者可以进行胆道引流术或外科旁路手术,不能手术的患者可以选择肝动脉灌注化疗。

Objective To summarize the diagnosis and cure exper ience of hilar cholangiocarinomas in 46 cases during the past 7 years. Methods Clincal manifestations, imaging features, tumor markers and operative procedures of 46 patients with hilar cholangiocarcinomas were ana lyzed. Results We found that main clinical performances were jaund ice,abdominal pain, fever, clay-colored stools, vomiting, loss of appetite, hi ccup. Positive rate of serum cancer antigen CA19-9 was higher. Sonography, CT, PTC, ERCP, MRCP and hepatic artery graphy showed different features respectively . Five patients were treated with hepatic artery perfusion chemotherapy, 25 pati ents with operation, includiog 11 cases of radical excision, 4 cases of internal drainage, 6 cases of external drainage and 4 cases of palliative operation. The complications of operation were pulmonary infection in 2 cases, bilary duct inf ection in 2 cases, sepsis in 1 case, incisive infection in 1 case. Three cases d ied in the hospital stay. Conclusions The diagnosis of hilar cholangiocarinomas should be combined clinical performances with examinations of laboratory, imaging and imm unohistochemistry. It should be confirmed that there is no carcinoma left at the incisive margin in radical operation. The patients with unresectable carcinomas should be treated with dile duct drainage, by-pass operation or hepatic artery perfusion.