肝门部胆管癌的影像分型及其与治疗的关系

InvestigationontherelationshipbetweenimagingclasificationandtreatmentofHepatichilarcholangiocarcinoma

目的：作者分析了７５例肝门部胆管癌，探讨其影像分型和治疗间的关系。材料与方法：患者男５７例，女１８例，年龄３０～７８岁。全部病例均经ＥＲＣＰ、ＣＴ和ＵＳ检查。结果：按Ｂｉｓｍｕｔｈ分型法，本组中Ⅰ型１９例，Ⅱ型８例，Ⅲ型１８例（Ⅲａ７例，Ⅲｂ１１例）及Ⅳ型３０例。总切除率２０％（１５例），其中Ⅰ型７例，Ⅱ型３例，Ⅲａ型２例，Ⅲｂ型３例，而Ⅳ型均未能切除。Ⅳ型较Ⅰ、Ⅱ及Ⅲ型的未能切除率有非常显著性差异（χ２检验，Ｐ＜０．０１）。６０例未切除中，４８例行引流管引流，９例行胆肠Ｒｏｕｘ－ｅｎ－Ｙ吻合术。未能切除的主要原因有局部或远处转移，侵犯肝动脉和（或）门静脉。放置引流管是一种较好的姑息疗法。结论：影像分型可为选择治疗方法提供重要的依据。

Purpose:Toinvestigateimagingclasificationasrelatedtotreatmentofhepatichilarcholangiocarcinoma.Materialsandmethods:Seventy-fivepatients(57menand18women,agerang-ingfrom30to78years)hadobstructionathilarlevelduetocancer.Diagnosisofhilarcholangiocar-cinomawasmademainlybasedoncharacteristicfindingsofimagingtechniques,includingendoscopicretrogradecholangiopancreatography(ERCP),computedtomography(CT)andultrasound(US)and/orelevatedbilirubinlevel.Results:HilarlesionsweregradedacordingtoBismuthclassifica-tion:19casesweretypeⅠlesion,8typeⅡ,18typeⅢ(7typeⅡaand11typeⅢb),and30typeⅣ.Thesurgicalresectionratewas20%(n=15cases,7casestypeⅠ,3typeⅡ,2typeⅢaand3typeⅢb).AltypeⅣlesionswereunresectable.Ofthe60unresectablecases,48casesweretreatedbydrainageofENBD,ERBDandEMBE,andin9patients,Rour-en-Ycholedochojejunostomywasperformed,significantdiferencewasfoundbetwentypeⅣandtypeⅠ,Ⅱ,andⅢpatientsintermsofunresectability(χ2test,P<0.01).Resectionwasimpossibleinsuchcaseswithlocalinfil-tration,distantmetastasis,invasionofthehepaticarteryand/orportalvein.Conclusion:Imagingclasificationplaysanimportantroleintheproperchoiceoftreatmentmethod.