老年肝门胆管癌的围手术期处理

Perioperative Management for Elder Patients with Hilar Cholangiocarcinoma

目的探讨老年肝门胆管癌的围手术期处理方法。方法回顾性分析1992年6月-2004年10月收治的60岁以上的肝门胆管癌患者临床资料。结果 78例患者合并有多脏器储备功能改变,施行手术切除12例,外引流手术11例,内引流手术55例。17例出现并发症,以肺部感染、肝肾功能衰竭和吻合口瘘为多见。根治性切除、姑息性切除和姑息性引流组手术后中位生存时间分别为12、8、5个月。结论肝门胆管癌的手术复杂,创伤大,对老年患者更容易产生心肺功能异常及各种并发症;但通过围手术期内合理、充分的综合治疗措施,仍能取得较好的治疗效果。

Objective To investigate the perioperative therapy for the elder patients with hilar cholangiocarcinoma. Methods The clinical data of over 60 years old patients with hilar cholangiocarcinoma who were treated in the hospital from June 1992 to October 2004 were retrospectively analyzed. Result Seventy-eight patients with multiple organs liver functional changes,12 patients received surgical excision,11 patients received external drainage surgery,55 patients received internal drainage surgery. Postoperative complications occurred in 17 patients,wost of which were lung infection,liver and kidney failure and anastomotic leakage. The median survival time were 12,eight and five months for the patients who received radical resection,palliative resection and drainage,respectively. Conclusions The surgical treatment for hilar cholangiocarcinoma is complicated with major surgical trauma. The postoperative complication and the cardio-pulmonary dysfunetion are easily happened especially in the aged patients. Intensive supportive therapy is needed all over the course.