肝门部胆管癌的外科治疗探讨

The Discussion of Surgical Treatment about Hilar Cholangiocarcinoma Patients

目的综合分析肝门部胆管癌的不同的手术方式及其远期疗效,探讨影响肝门部胆管癌的手术方式的选择及疗效的相关因素。方法回顾重庆市九龙坡第二人民医院治疗112例肝门部胆管癌的纪录,分析切除率、并发症及病死率等,并综合文献进行讨论。结果根治性切除手术难度大,甚至联合肝切除亦难以达到根治目的,根治性切除率只有43.7%。随访72例中,根治切除者1、2、3年生存率分别为62.2%、33.6%、13.4%;姑息切除者1、2年生存率为54.3%、13.3%,无3年生存者;非切除性胆管内、外引流者1、2年生存率为26.2%、12.1%,无3年生存者。结论肝门部胆管癌的治疗仍以手术切除为主,只有根治性切除才能获得最佳疗效,联合肝叶、血管、淋巴结等切除的扩大根治术可延长患者生存期。

Objective To analyze different surgical strategies and their effects on HCC, and to explore the factors that influence the surgical strategies and outcomes. Methods Date of 112 patients with HCC treated surgery in second people＇ s hospital of Jiulongpo district were analyzed retrospectively, including the resection rate, operative morbidity and mortality. Result The radical resection was difficult to reach even supplemented by liver lobectomy. Radical resection was only 43.7%.In 72 followed-up patients, the 1, 2, 3-year survival rate was 62.2%, 33.6%, 13.4% in radical resection group, and 54.3%, 13.3%, no one survived for more than 3 years; whereas in nonresectional internal and drainage group, 1, 2-year survival rate was 26.2%, 12.1%, no one survived for more than 3 years. Conclusion With HCC, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive.