肝门部胆管癌149例临床分析

Clinical Analysis for 149 Cases of Hilar Cholangiocarcinoma

[目的]总结同一单位肝门部胆管癌外科治疗的阶段性经验.[方法]回顾分析1998～2003年收治的149例肝门部胆管癌患者的临床资料.[结果]149例中手术切除91例,非切除行胆道手术引流35例,经十二指肠镜及经皮经肝胆管内支架引流9例,单纯剖腹探查5例,其余9例因特殊原因未作任何处理而出院.随访103例中切除组术后1、3、5年生存率分别为76.56%、26.56%、7.81%;非切除手术引流组及胆道内支架引流组1年生存率分别是38.46%和37.50%,无3年生存者;单纯剖腹探查者5例,均于3个月内死亡.[结论]切除性治疗是延长肝门部胆管癌患者生存期,改善生活质量的关键.对不能手术切除的患者,胆道内支架支撑引流且具有简便有效、创伤小、并发症少的优点.

[Objective]To summarize clinical experiences in surgical management for hilar cholangiocarcinoma in a single center. [Methods]Clinical data of 149 patients with cholangiocarcinoma treated in our institute between 1998 and 2003 were investigated retrospectively. [Results]Of the 149 patients, 91 underwent resection, 35 subjected to unresectional internal or external drainage surgically, 9 drainaged with stents insertion via PTC or ERCP and 5 only laparotomy. Other 9 patients left hospital without any treatment. In 103 followed-up patients,the 1,3,5year survival rate were 76. 56%.26. 56%and 7. 81% in resection group. In unresectional drainage and biliary stents insertion group, 1 year survival rate was 38.46% and 37.50% respectively, no one survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. [Conclusion]Surgical resection is crucial for prolonging survival time and improving life quality in patients with hilar cholangiocarcinoma. In unresected patients, the biliary stents insertion is associated with effectiveness, easy to operate, slight operation trauma and lower morbidity.