老年高位胆管癌的手术治疗方法与疗效分析

Operation of high level cancer of bile duct of aged

目的探讨老年人高位胆管癌的手术治疗方式及临床疗效。方法对17例经手术治疗的老年高位胆管癌病人的临床资料进行回顾性分析。结果完成根治性切除7例(根治组),仅行姑息性切除10例(非根治组)。根治组中位生存期为23.2个月,非根治组中位生存期为11.3个月,两者有显著差异(P<0.05)。非根治组中内引流者中位生存期为12.7个月,而外引流者中位生存期仅为5.6个月,两者有显著差异(P<0.05)。结论积极提高手术切除率是改善老年人肝门部胆管癌预后的惟一有效方法,清扫肝十二指肠韧带、适宜的肝部分切除可提高根治性切除率;姑息性切除、胆道引流特别是外引流有助于改善患者生活质量,但对延长生存期贡献有限。

Objective To evaluate surgery therapy manner of elderly hilar cholangiocarcinoma（HCCA）.Methods The clinical data of 17 the aged patients with hilar cholangiocarcinoma surgically treatedwere retrospectively analyzed.Results Surgical removal was performed in 6 cases,and non-surgical drainage between hepatic duct and jejunum was done in 11 cases.Among the 17 elderly cases followed up,6 cases belonged to the surgical removal group and had a medium survival of 23.2 months,and 11 cases belonged to the non-surgical drainage group and had a medium survival of 11.3 months.There was a significant difference in the median survival between the two groups（P0.05）.Conclusion It is very important to improve the prognosis of elderly hilar cholangiocarcinoma and increase the radical resection rate.The combination procedure of skeletonization of hepatoduodenal ligament partial liver resection and the excision and reconstruction of invaded hilar blood vessels may raise the radical resection rate.