103例肝门部胆管癌的外科手术切除治疗

Experience of surgical resection of 103 hilar cholangiocarcinoma

目的总结103例肝门部胆管癌采用手术切除治疗的经验。方法回顾性分析10年来行手术切除的肝门部胆管癌103例患者的临床资料和随访结果。结果本组行根治性(R0)切除43例,根治性切除率为41．7％,非根治性(R1,R2)切除60例(58．30%),术后发生并发症34例,手术死亡8例。根治性切除组中位生存期29．9个月,1、3、5年生存率分别为69．6％、42．0％、20．9％,明显优于非根治性切除组34．1％、10．2％、0(P<0．05)。本组近5年术前减黄治疗42例,合并肝切除达53．8％,根治性切除率达45．7％,中位生存期24．7个月,疗效明显提高(P<0．05)。结论肝门部胆管癌作根治性手术切除能更好延长患者生存期,使手术治疗获得良好的疗效。随着近年来加强围手术期处理、术中行切缘冰冻病理检查、联合肝切除等提高了肝门部胆管癌根治性切除率。

Objective To summarize the experience of surgical resection of 103 hilar cholangiocarcinoma. Methods One hundred and three consecutive cases of hilar cholangiocarcinoma who underwent surgical resection at our hospital over the past ten years were reviewed retrospectively. The clinical data and long-term outcome were analyzed. Results Out of 103 cases, 43 patients underwent radical resection （41.7 % ）, and 60 patients underwent palliative resection. There were 34 patients developed postoperative complications and 8 patients died in hospital. For the radical resection group, the median survival time was 29.9 months and 1-year, 3-year, 5-year survival rate was 69. 6%, 42. 0%, 20. 9%, respectively, which was significant greater than 34. 1% 、 10. 2% 、0 of the palliative resection group （P 〈 0. 05 ）. Over the past five years, 42 cases underwent pre-operative drainage of bile and the rate of combined liver resection reached 53. 8%. The tumor radical resection rate has increased to 45.7% , the median survival time have reached 24. 7 months （P〈0. 05 ）. Conclusions Improvement of pre-operative management, intraoperative pathology for resection margin, and combined liver resection may help in increasing the radical resection rate. Radical resection can improve postoperative survival, and produce a satisfactory outcome for patient with hepatic hilar cholangiocarcinoma.