54例肝门部胆管癌手术切除技术体会

Experience in resection of hilar cholangiocarcinoma: a report of 54 cases

目的总结肝门部胆管癌手术治疗中提高根治切除率和减少并发症发生率的经验。方法回顾性分析1998年1月至2004年12月手术切除肝门部胆管癌病例的临床资料及随访结果。结果本组共54例患者切除肝门部胆管癌,切除率63.5%(54/85)。其中合并肝切除14例;合并胰头十二指肠切除3例;合并门静脉壁部分切除2例;合并肝固有动脉切除2例,重建1例。根治手术为30例。手术根治切除率由27.0%(2001年以前)提高到41.7%(2001年后),严重并发症如肝功能衰竭、感染的发生率以及围术期死亡率均得以良好控制。总体1、2、3年生存率为67.4%、28.1%和13.5%,根治手术1、2、3年生存率分别为86.5%、36.4%和23.7%,姑息切除1、2年生存率分别为41.2%和17.6%。结论提高肝门部胆管癌的手术技巧能够显著改善根治切除率,降低严重并发症发生率。

Objective To summarize the experience in ameliorating curative resection rate and major postoperative complication rate for treatment of hilar cholangiocarcinoma. Methods Respective analysis was made on the clinical data of 54 consecutive cases who underwent resection of hilar cholangiocarcinoma from Jan. 1998 to Dec. 2004. Results In this group 54 cases received tumor resection with a resection rate of 63.5%. Combined partial hepatectomy was performed in 14 patients, while combined pancreaticoduodenectomy（Whipple） in 3 patients, and combined resection of portal vein in 2 patients and combined resection of hepatic artery in 2 patients. Thirty patients had curative resection. The curative resection rate was greatly increased from 27.0% （ before 2001 ） to 41.7% （ after 2001 ） in this group with well controlled perioperative mortality and postoperative complications rate （ e. g. hepatic failure and major infection）. The gross 1-,2-,and 3- year survival rates for the whole group were 67.4% ,28. 1% and 13.5% respectively. The 1-, 2-, and 3- year survival rates for curative resection were 87%, 36% and 24% respectively. The 1-, 2- year survival rates for palliative resection were 42% and 18%. Conclusions Enhanced surgical technique resulted in better clinical outcomes.