肝门部胆管癌的临床分析

Clinical Analysis in Kilar Cholangiocarcinoma

目的:分析探讨肝门部胆管癌的临床特点和手术治疗效果。方法:回顾性分析总结70例肝门部胆管癌的临床资料,对其临床分型,不同的手术方法及随诊治疗结果进行了统计学分析。结果:按Birmuth-Corlette分型法,Ⅰ型8例,Ⅱ型16例,Ⅲa型20例,Ⅲb型12例,Ⅳ型14例。17例确诊前曾有胆囊结石和(或)肝内外胆管手术史,22例患有胆囊结石或胆管结石或同时患有胆囊和(或)胆管结石。B超、CT及MRCP胆道的确诊率分别为75.7%、80%、91.4%。70例患者中,根治性切除8例,姑息性切除12例,胆道引流术36例,未手术14例。总手术率80%(56/70),根治性切除率13.4%(8/70)。根治性切除的患者1、2、3年生存率分别为75%(6/8)、50%(4/8)、12.5(1/8)。姑息性切除的患者1、2、3年生存率分别为50%(4/8)、12.5%(1/8)、0。两组生存率差异有统计学意义(P<0.05);胆道引流患者的1,2,3年生存率分别为25%(2/8)、12.5%(1/8)、0。非手术患者的平均存活时间为5个月,1例超过1年。结论:胆石症可能是肝门部胆管癌的重要诱因,提高手术切除率是改善肝门部胆管癌预后的有效方法,肝十二指肠韧带骨骼化,肝部分切除术可提高根治性切除率。

Objective： To evaluate the clinical features and surgical efficacy of kilar cholangiocarcinoma. Methods：Clinical data of 70 cases of kilar cholangiocarcinoma were retrospectively summarized. Their clinical typing, surgical methods and efficacy were statistically analyzed. Results：According to the Bismuth - Corlette staging system, 8 cases were in type Ⅰ , 16 in type Ⅱ, 20 in type Ⅲa, 12 in type Ⅲb, 14 in type Ⅳ. There were cholecystolithiasis and or surgery for intrahepatic or extrahepatic bile duct in 17 cases, and cholecystolithiasis or calculus of bile duct or both of them in 22 cases. The accurate rate of diagnosis of ultrasound, CT and MRCP was respectively 75.7 %, 80 % and 91.4 %. of 70 cases, 8 performed radical resection, 12 palliative resection, 36 biliary drainage, and 14 conservative therapy. The total rate of surgery was 80 %, the rate of radical resection was 13.4 %. The 1, 2, 3 year survival rate of cases,performing radical resection was respectively 50 %, 12.5 % and 0 %. There was statistical difference in survival rate between two groups（P 〈 0.05）. The 1, 2, 3 year survival rate of cases performing biliary drainage was respectively 25 % , 12.5 % and 0 %. The average survival time of cases without surgery was 5 months, 1 cases lived over 1 year, Conclusion： Cholecystolithiasis is the main factor of cholangiocarcinoma, The radical resection is effective in improving prognosis 0f cholangiocarcinoma. Skele- tonization of hepatoduodenal ligament with partial liver resection can improve the rate of radical resection for haliar cholangiocarcinoma.