92例肝门部胆管癌的外科治疗分析

Surgical Treatment in Hilar Cholangiocarcinoma

目的:探讨肝门部胆管癌的外科手术治疗方法及其疗效。方法:对舞钢市人民医院及郑州大学第一附属医院收治的92例肝门部胆管患者的病历资料及随访结果进行分析。92例患者中手术治疗79例,包括根治性性切除28例、姑息性切除18例、内引流或外引流术33例。另有7例行PTCD置管,6例放弃治疗。结果:手术病死率1.1%,根治性切除率35.4%,根治性切除的患者1、3和5年存活率分别为78.6%、50%和28.6%。姑息性切除的切除率22.8%,姑息性切除的患者1、3和5年存活率分别为55.6%、22.2%和11.1%。根治性切除和姑息性切除两组患者生存期差异有统计学意义(P<0.05)。手术切除的生存率则明显高于各种引流术和介入手术,差异有统计学意义(P<0.05)。结论:根治性手术目前仍是肝门部胆管癌的主要治疗方式,肝门部胆管癌的预后与组织学分化程度、手术治疗方式等多种因素相关。

Objective：To investigate the surgical therapies and their curative effectiveness in the treatment of hilar cholangiocarcinoma（HCC）.Methods：We collected and used statistical methods to analyze the clinical information and follow-up for the treatment of 92 cases from January 2000 to June 2010 in the First Affiliated Hospital of Zhengzhou University and the people＇s hospital of wugang.In these cases,7 cases underwent PTCD catheterization,6 cases abandoned treatment There are 79 cases underwent surgical exploration,including 11 cases for extended radical surgery,17 cases for radical surgery;18cases for palliative surgery;33cases for surgical drainage：We statisti-cated the clinical types,surgical methods,pathological classification,survival rate and their relations.Results：The operative mortality rate was 1.1%.The Resection rate of radical surgery is 35.4% ;the 1,3,and 5-year survival rate of patients with radical surgery are 78.6%,50% and 28.6%.The Resection rate of palliative resection is 22.8%,the 1,3 and 5-year survival rate of patients with palliative surgery are 55.6%,22.2% and 11.1%.The survival rate of patients with radical resection was significantly higher than palliative surgery（P0.05）.The survival rate of surgery was significantly higher than that of various drainage and interventional procedures（P0.05）.Conclusions：Radical surgery is the main treatment of hilar cholangiocarcinoma,The prognosis of Hilar cholangiocarcinoma related to tumor staging,degree of histological,surgical treatment and other factors.