肝门部胆管癌的外科治疗及预后分析(附61例报告)

SURGICAL TREATMENT AND PROGNOSTIC ANALYSIS OF HILAR CHOLANGIOCARCINOMA:A REPORT OF 61 CASES

目的探讨高位胆管癌的外科手术及影响预后的因素,以提高对高位胆管癌的认识。方法回顾性分析2002年1月至2007年12月61例高位胆管癌的外科治疗的临床资料。结果61例高位胆管癌按Bismuth-corlitte分型,Ⅰ型5例,Ⅱ型12例,Ⅲa型10例,Ⅲb型8例,Ⅳ型26例。根治切除31例,姑息手术13例,内引流13例,PTCD4例。根治切除组平均中位生存期29.3个月,其1,3,5年生存率分别为75%,39.3%,3.6%。姑息手术组平均中位生存期18.9个月,1,3,5年生存率分别为72.7%,9.1%,0%。内引流组平均中位生存期4.5个月,1,3,5年生存率分别为20%,0%,0%。根治手术组生存率高于姑息手术组(χ2=14.20,P=0.0002)。姑息手术组术后生存率高于内引流组(χ2=4.68,P=0.0305)。多元回归分析显示,切缘阳性,肿瘤分期,淋巴结转移是影响预后的独立因素。结论外科根治手术是治疗肝门部胆管癌唯一有效的手段。

Objective To investgate surgical treatment for hilar cholangiocarcinoma and analys the prognostic factors after operation. Methods From January 2002 to December 2008,61 cases of Hilar bile duct cancer were retrospectly analysed. Results In Bismuth-corlitte classification ,5 cases were Ⅰ category, 12 Ⅱ category, 10 Ⅲa category, Ⅳ b category. Of all the cases ,31 patients underwent rasical resection, 13 patients underw 8ent palliative operation, 13 internal biliary drainage and 4 cases received PTCD. The 1-, 3-and 5-years survival rate of radical group, palliative group and internal biliary drainage group were 75% ,39.3% ,3.6% ;72. 7% , 9. 1% ,0% and 20% ,0% ,0% respectively. Survival rates of radical group is bighter than palliative group （x^2 = 14. 20,P =0. 0002）. And survival rates of palliative group is highter than internal biliary drainage group （x^2 =4. 68 ,P =0. 0305 ）. Multivariate analysis revealed that tumor-free margins, pTNM and lymphatic metastasis were independent prognosis factors affecting survival, Conclusions Radical resection is the only one procedure to cure hilar cholangiocarcinoma which can provide long-term survival .