肝门部胆管癌52例分析

Clinical analysis of 52 patients with hilar cholangiocarcinoma

目的探讨肝门部胆管癌早期诊断方法和手术方式对患者预后的影响。方法回顾性分析经手术和病理确诊的肝门部胆管癌52例临床特征、手术方式和随访结果。结果本组手术切除28例,总手术切除率53.8%,其中根治性切除19例、姑息性切除9例、行胆管内、外引流术24例。随访根治性切除10例中1.5年、2年、2.5年生存率分别为80%(8/10)、50%(5/10)、20%(2/10),最长生存者至今已30个月。姑息性切除8例中1.5年生存率仅为12.5%(1/8)。结论肝门部胆管癌早期诊断主要依靠影像学。B 型超声操作简单、无创伤应为首选,联合应用 CT、经皮经肝胆管造影术(PTC)、内窥镜逆行胆胰管造影术(ERCP)和术中活检,可明确诊断。治疗应力争根治性切除,非切除者以内引流术为主,可延长生存时间和提高生活质量。

Objective To investigate measures of early diagnosis and evaluate surgical therapy of hilar cholangiocar- cinoma.Method Retrospective analysis was made on the clinical features,operations undertaken and follow- up results in 52 patients with hilar cholangiocarcinoma admitted into our hospital between 1983 to 1997,in whom the diagnosis was proved by laparotomy and pathology.Result 28 cases underwent tumor resection (53.8%),with radical resection in 19,palliative resection in 9.Non-resectional treatment was carried out in 24 cases with internal drainage in 11,external in 10 and PTCD in 3.In the radical resection group,the 1.5,2 and 2.5-year survival rates were 80%、50% and 20%,and the longest survival is now 30 months postop,whereas in the palliative resection group,the 1.5-year survival rate was only 12.5%.Conclusion The symptoms of this disease were inconspicuous and insidious.The diagnosis thus is liable to come too late.Apart from clinical manifestation,early diagnosis often depends mainly on the imaging technics and ultrasonography should be the first choice.Other radiological techniques,such as CT scanning,PTC,ERCP and intraoperative biopsy will also be of help.Radical resection should be attempted if feasible.Cholangioenterostomy is of choice in patients in which tumor resection could not be performed.