肝门部胆管癌53例手术治疗分析

Surgical treatment of hilar cholangiocarcinoma： experience of 53 cases

目的总结53例肝门部胆管癌手术的临床经验，探讨提高其手术疗效的方法。方法将53例手术治疗的肝门部胆管癌患者按时间顺序分为Ⅰ组（1998年1月至2002年12月共22例）和Ⅱ组（2003年1月至2008年1月共31例）。对两组临床及随访资料进行回顾性对比分析。结果手术切除率[根治切除（R0）＋姑息切除（R1）]Ⅰ组为40．9％，显著低于Ⅱ组的71．0％（χ^2=4．789，P=0．029）。肝叶切除率I组为30．0％显著低于Ⅱ组的64．5％（χ^2=5．796，P=0．016）。肝叶切除率与手术切除率高度相关（χ^2=0．985，P〈0．01）。Kaplan—Meier生存分析显示，中位生存时间R0切除〉R。切除〉姑息引流[分别为（27．0±4．5）个月、（10．0±0．7）个月、（4．0±0．5）个月，P〈0．01]。R0切除中腹腔干淋巴结转移阳性的中位生存期显著低于阴性者（分别为17．0个月和27．0个月，P=0．034）。R1切除中合并与未合并肝叶切除的中位生存期无差异[分别为（10．0±1．1）个月和（10．0±0．4）个月，P=0．811]。结论手术切除仍是肝门部胆管癌的确定性治疗手段，根治性切除能使患者获得最长生存期。联合肝叶切除可提高手术切除率，但对于仅能达到姑息切除或腹腔干淋巴结转移阳性者，联合肝叶切除并未能延长患者生存期。

Objective To summarize the experience of surgical treatment of the hilar cholangiocarcinoma and explore the factors influcing the operative effect. Methods Fifty-three cases of hilar cholangiocarcinoma performed operation from January 1998 to January 2008 were divided into two groups： Group I included cases treated from January 1998 to December 2002（totally 22 cases） ; Group 11 included cases treated from January 2003 to January 2008 （totally 31 cases）. Comparative study was carried out between these two groups. Results Surgical resection [ radical resection （ R0 ） ± palliative resection （ R1 ） ] rate in group Ⅰ was lower than that in group Ⅱ （40. 9% vs. 71.0%, P =0. 029）. Hepatolobectomy rate in group I was lower than that in group Ⅱ（ 30. 0% vs. 64. 5%, P = 0. 016 ）. The resection rate was positively correlated with the hepatolobectomy rate （r = 0. 985, P 〈 0. 01 ）. The median survival time of the patients underwent Ro resection was longer than that in the patients underwent R1 resection and palliative bile duct drainage [ （27. 0 ±4. 5） months vs. （ 10. 0 ± 0. 7 ） months vs. （4. 0 ± 0. 5 ） months, respectively, P 〈 0. 01 ]. Conclusions Early diagnosis and radical resection are important to improve the prognosis for patients with hilar cholangiocarcinoma. But for the patients could only receive palliative resection or with positive celiac trunk lymph nodes, combined liver lobe resection could not improve the survival.