肝门部胆管癌85例诊治分析

Experience of the therapy of 85 patients with hilar cholangiocarcinoma

目的探讨肝门部胆管癌的治疗方法及其临床效果。方法回顾性分析我院1996年1月-2007年12月收治的85例肝门部胆管癌的临床资料。结果本组有78例获得随访，平均随访时间为24月（2月～5．5年）。手术切除28例，中位生存时间为20月，1、3、5年生存率分别为71．4％、28．6％、3．6％；手术引流31例，中位生存时间为11月，1年生存率为29．0％，无3年生存者，手术切除组疗效优于手术引流组（P〈0．05）。介入引流26例，中位生存时间为8月，1年生存率为38．5％，介入引流组疗效与手术引流组相似（P〉0．05）。手术切除联合肝动脉灌注化疗8例，中位生存时间为22月；单纯手术切除20例，中位生存时间为16月，两组疗效相比有显著性差异（P〈0．05）。结论根治性切除是治疗肝门部胆管癌最有效的方法。手术引流与介入引流治疗效果相似，但介入治疗创伤小、恢复快。手术切除联合介入化疗可提高疗效。

Objective To summarize the experience of therapy of hilar cholangiocarcinoma. Methods The clinical data and long-term outcome of 85 cases of hilar cholangiocarcinoma were analyzed retrospectively. Results Out of the 85 cases,78 patients were followed-up. In the surgical resection group,the median survival time was 20 months and 1-,3-, and 5-year suruival rate was 71.4%, 28. 6% and 3. 6%, respectively, which was significantly greater than 29. 0% 0,0 of the surgical drainage group（P〈0. 05）. In the inteventional drainage group, the median survival time was 8 months and 1-year survival rate 38. 5% ,which wasn＇t significantly greater than in the surgical dranage group（P〉0. 05）. In the group of surgical resection and transcatheter arterial chemotherapy, the median survival time was 22 months,which was significantly longer than in the surgical resection group（P〈0. 05）. Conclusion The best prognosis can be achieved by radical excision for patient with hepatic hilar cholangiocarcinomar. There is similar effect between the surgical drainage group and interventional drainage group, but interventional therapy is safer with less injury. Interventional chemotherapy combined with excision may prolong the survival.