肝门部胆管癌的临床肿瘤行为和外科治疗

Clinico-oncological behavior and surgical treatment of perihilar cholangiocarcinoma

目的研究肝门部胆管癌的临床肿瘤行为和外科治疗效果。方法回顾性分析1980年1月～2005年12月单机构收治的92例患者的临床表现、肿瘤行为和术后生存。结果肝门部胆管癌的主要临床症状为黄疸(97%,89例)、体重下降(39%,36例)、上腹不适(33%,30例)、上腹痛(27%,25例)。90%(83例)SGPT升高、37%(34例)低蛋白血症。Bismuth分型Ⅰ型29%(27例)、Ⅱ型22%(20例)、Ⅲ型16%(15例)、Ⅳ型33%(30例)。总体手术并发症33%(30例)、手术死亡率3%(3例)。39%(36例)切除、切缘阴性率53%(19例)。不能切除的患者62%(35例)局部广泛侵犯,39%侵犯大血管(22例),21%(12例)远处转移。总体中位生存8个月,手术切除后25个月、非切除性手术后5个月(P<0.0001)。结论局部侵犯(特别是大血管侵犯)和远处转移是肝门部胆管癌不能切除的主要原因。手术切除能够显著提高术后生存。

Objective To investigate the clinico - oncological behavior and surgical effect of perihilar cholangiocarcinoma. Methods A retrospective analysis had been accomplished of 92 patients with perihilar cholangiocarcinoma. Results The major symptoms were jaundice （97%, n = 89）, weight loss （39%, n = 36）, abdominal discomfort （33%, n = 30） and pain （27%, n = 25）. According to Bismuth classification, there were 29% Ⅰ type（n=27）, 22%Ⅱ （n=20）, 16% Ⅲ （n=15） and33% Ⅳ（n=30） respectively. 33% （n = 30） patients caught postoperative complications and 3 % （n = 3） died, witth resection rate 39% （ n = 36）, among those 53% （n = 39） received radical resection. Distant metastasis （21%, n = 21） and local widespread infihration （62%, n = 35）, especially involvement of large vessels were the main reasons leading to unresectability. The median survival was 8 months, in those with tumor resection 25months and those without only 5 months （P 〈 0.001, log - rank test）. Conclusion Unresectable cholangiocarcinoma mainly accomplished with local infiltration or/and metastasis. Removal of tumor could prolong survival significantly.