129例肝门胆管癌的临床治疗分析

Analysis of the efficacy of surgical treatment for 129 cases of hepatic

目的探讨肝门胆管癌的外科治疗及疗效分析。方法回顾性分析2000年1月~2007年9月我院129例肝门胆管癌的临床资料。结果手术113例,其中60例行根治性手术切除,切除率53.9%;R0切除48例,R1、R2切除12例;53例行引流,术中46例行内引流,7例行外引流;16例未手术。根治性切除的中位生存期47.86个月,高于未切除的10个月及减黄手术的14.83个月。根治性手术的1、3、5年的生存率分别为95.83%、62.50%、33.33%,明显高于姑息性手术的56.92%、12.31%、0%和未手术的31.25%、0%、0%。结论（1）根治性手术是治疗肝门胆管癌的主要手段。（2）当肿瘤侵及汇合部胆管时应行尾状叶切除。（3）姑息性治疗在于提高病人的生活质量。

Objective To investigate the surgical treatment and its efficacy for hepatic portal cholangiocarcinoma. Methods Aretrospective clinical analysis was made in 129 patients with hepatic portal cholangiocarcinoma, treated in our hospital from January 2000 to September 2007. Results Of all 129 cases, 113 cases have been surgically explored, 16 patients have not been operated. Among the 113 cases,60 cases had been radical resection with a resection rate of 53.9%, R0 resection was performed 48 cases, and R1 or R2 palliative resection for 12 cases, among the radical resection, the hepatic lobectomy including partial caudate resection was performed in 30 cases, in which positive margin of the caudate lobe duct was found in 9 cases by pathological examination. 53 cases have been explored, but their cancers could not be resected and only bypass drainagecould be done, biliary - enteric drainage for 46 cases and of external drainage for 7 cases. The median survival period（47.86 months） of radical resection group was longer than that of palliative surgery group（ 14.83 months）, the median survival period of 16cases ,who did not have surgery was（ 10 months ） the 1 - , 3 - and 5 - year survival rates of radical resec- tion group were 95.83% ,62.50% and 33.33% respectively, which were longer than those of the palliation therapy group with the 1 - , 3 - and 5 -year survival rates of 56.92% , 12.31% and 0%, Whereas the 1 - , 3 - and 5 -year survival rates of 16 cases without opera- tion were 31.25%, 0%, 0% respectively. Conclusion（ 1 ） Radical resection is the main therapy for hepatic portal cholangiocarcinoma. （2） If tumor invades the bifurcation of the common hepatic duct ,the caudate lobe should be resected. （3） The palliation therapy of patients with uureseetable cholangiocarcinoma should be centered in raising the patientslife quality.