联合肝叶切除治疗肝门部胆管癌(附74例报告)

Clinical analysis of patients’ operative patterns and complications with curative resection and hepatectomy.

目的研究肝门部胆管癌联合肝脏切除的手术方式、并发症及疗效。方法总结1993-2004年中国人民解放军总医院肝胆外科联合肝叶切除治疗肝门部胆管癌74例临床资料。结果联合行左半肝切除50例,右半肝切除14例,尾状叶切除2例,右三叶、右前叶切除各2例,左内叶切除4例;手术并发症发生率36·5%,围手术期死亡1例。随访率82·4%,1,3,5年存活率为75·4%、24·4%、12·2%,最长一例现已无瘤存活8年。结论肝门部胆管癌应积极手术切除治疗,对无明显手术禁忌证的病人行肿瘤切除联合肝叶切除的扩大根治术可延长病人存活期;围手术期正确处理,是减少术后并发症,提高病人生活质量和延长存活期的关键。

Objective To summarize experience in curative resection with hepatectomy of hilar cholangiocarinoma. Methods A retrospective analysis was performed in 74 cases of hilar cholangiocarcinoma. Results 50 with left hepatectomy, 14 with fight hepatectomy ,2 with extended fight hepatectomy,2 with left medial segmentectomy,4 with left medial segmentectomy ,2 with caudate lobectomy. The 1,3,5 - year survival rate was 75.4% ,24.4% ,12. 2%. Conclusion The treatment of curative resection with hepatectomy plays an important role for curative effect and long term survival rate in patients with H - CC. Appropriately perioperative care can reduce the operative morbidity and mortality.