BismuthⅢ型肝门胆管癌的外科治疗体会

Surgical treatment experiences of Bismuth type Ⅲ hilar cholangiocarcinoma

目的:总结BismuthⅢ型肝门胆管癌(hilar cholangiocarcinoma,HCC)的外科治疗经验。方法:回顾性分析2005年6月-2007年12月行手术治疗的39例BismuthⅢ型HCC患者资料。其中Ⅲa型16例,Ⅲb型23例。结果:30例完成切除手术,其中R0根治性切除16例,R1姑息性切除8例,R2姑息性切除6例,手术切除率77%(30/39),根治性切除率53%(16/30)。R0根治性切除组14例获得随访,1年生存12例,3年生存7例;R1姑息性切除组全部获得随访,1年生存5例,3年生存2例;R2姑息性切除组4例获得随访,1年生存2例,3年生存0例。另9例未完成病灶切除,行经肿瘤切开放置Y管内支架引流6例,胆囊桥式肝管-十二指肠吻合3例。9例患者中6例获得随访,1年生存1例,3年生存0例。结论:BismuthⅢ型HCC应积极手术治疗,根治性切除能明显改善预后。

Objective： To summarize the surgical treatment experiences of Bismuth type Ⅲ hilar cholangiocarcinoma. Methods： Thirty-nine patients with Bismuth type Ⅲ HCC were surgically treated from June 2005 to December 2007 and were retrospectively analyzed （type Ⅲ a, 16 patients; type Ⅲb, 23 patients）. Results： Thirty patients （77%） ultimately underwent resection with curative intent. In the resection group, 16 patients （53%） were applied with Ro radical resection, while the number of R, resection and R2 resection was 8 and 6,respectively. In R0-resection group, 14 cases were followed up and the 1-, 3-year survival was 12, 7 cases respectively. In R1-resection group, the 1-, 3-year survival was 5, 2 cases respectively. In R2-resection group, 6 cases were followed up and the 1, 3-year survival was 2, 0 cases respectively. The other 9 patients did not undergo resection, endoprosthesis drainage through Y tube was used in 6 patients and gallbladder bridge hepatoduodenostomy was performed on 3 patients. Six cases of them were followed up and the 1-, 3-year survival was 1, 0 cases respectively. Conclusion：The radical resection might improve the prognosis of the patients with Bismuth type Ⅲ hilar chotangiocarcinoma.