肝门部胆管癌的手术治疗：附41例报告

Surgical treatment of hilar cholangiocarcinoma:a report of 41 cases

目的探讨肝门部胆管癌手术疗效及其预后的相关因素。方法对近7年来收治的经病理诊断确诊的41例肝门部胆管癌患者的临床资料进行回顾性分析。结果41例肝门部胆管癌患者中,术前影像检查联合诊断正确率为95.1%;行手术切除32例,总手术切除率为78.1%,其中根治性切除15例,姑息性切除17例;胆管内引流术9例。全组住院期间死亡2例,病死率4.9%。手术切除组中位生存时间和1,3,5年生存率分别为28个月和70.0%,40.0%,23.3%,内引流组为8个月和44.4%,11.1%,0,手术切除组患者的生存率优于引流组(P<0.05和P<0.05)。其中施行R0有14例,占46.7%,其中位生存时间和1,3,5年生存率为52个月和85.7%,64.3%,35.7%,不同手术级别的术后疗效存在差别(P<0.05)。Bismuth分型以Ⅱ型生存率最高,有7例,占18.0%,其中位生存时间和1,3,5年生存率为72个月和85.7%,71.4%,42.9%;不同病理类型切除率中以乳头腺癌和高分化腺癌为最高的切除率分别为77.8%和78.3%,其1,3,5年的生存率分别为77.8%,44.4%,33.3%和73.9%,65.2%,17.4%;低分化癌为20%,0,0。结论肝门部胆管癌手术治疗的预后主要与肿瘤的临床病理特征和手术方式相关,根治性切除是改善肝门部胆管癌长期生存和预后的关键因素。

Objective To explore the factors related to effects and prognosis of surgical treatment of hilar cholangiocarcinoma, Methods The clinical data of 41 patients with hilar choIangiecarcinoma （HCCA） admitted in recent seven years were investigated and anlyzed retrospectively, Results Among 41 patients with HCCA, the accuracy rate of diagnosis by imaging technology was 95. 1% before operation, Thirty-two eases were treated by surgical resection, of which 15 cases had radical resection and 17 cases had palliative resection, the total resection rate was 78. 1% , and 9 cases had biliary internal drinage procedure. Two cases died during hospitilization. The rate of one-, three-and five-year survival for surgical resection was 70,0% ,40.0% and 23, 3% respectively, and for palliation drainage was 44, 4%, 11.1%,and 0%, respectively, The median survial time was 28 months and 8 months for surgical resction and palliation drainage, respectively. The difference between surgical resction and palliation drainage on survival rate and median survival time was signigicant （ P 〈 0.05 and P 〈 0.05 respectively ） . In 14 of the cases were treated with R0, the 1-,3-and 5-year survival rate and median survival time was 85, 7% ,64, 3% ,35, 7% and 52 months respectively ; and different rank of operation had different curative effects （ P 〈 0.05 ） , Acording to Bismuth type, type Ⅱ had a the higher survival with 1- ,3-and 5-year survival rate and median survival time of 85.7% ,71. 4% ,42. 9% and 72 months respectively. The resection rate for papillary and highly differentiated adenocarcinoma was 77.8 % and 78.3% , respectively, and the 1-, 3-and 5-year survival rate was 77.8%, 44.4%,33.5%,and 75.9%,65.2% 17.4%, respectively; while it was 20%, 0% and 0% respectively for low differentiated carcinoma. Conclusions The curative efficacy of surgery and postoperative prognosis of HCCA depend largely on different clinical characteristics, pathological type and surgical method. Radical resection plays a key role to improve long-term survival.