肝门部胆管癌18例临床分析

目的探讨肝门部胆管癌的诊断和治疗方法。方法回顾分析18例肝门部胆管癌诊断和治疗的经验。结果 18例患者均经结合临床表现及实验室检查和影像学检查明确诊断。18例患者中6例行开腹手术治疗,其中2例达R0切除,但1例因术后并发症在围手术期死亡。2例行手术切除但切缘有肿瘤残留。2例无法切除肿瘤只能行胆肠内引流术。6例行PTCD治疗。5例不愿行手术或经皮肝穿刺胆道引流等治疗而自行出院。1例在外院已经行放射治疗。结论肝门部胆管癌的诊断主要依赖于实验室检查和影像学检查,治疗方法以手术治疗效果最佳,但手术根治率不高,且手术并发症可引起死亡。经皮肝穿刺胆道引流等介入治疗作为减轻黄疸的方法可运用于术前减黄或姑息治疗。

Objective To discuss how to diagnosis and treat hilar cholangiocarcinoma.Methods The experience in handling 18 cases with hilar cholangiocarcinoma were reviewed and analyzed.Results Eighteen cases were all diagnosed by clinical manifestations and laboratory tests and imaging diagnosis.Six of 18 cases underwent laparotomy. Two cases were resected completely.But one case died of complications in perioperative period. Two cases had residual tumor at the cutting edge. Two cases took biliary drainage operation because tumor could not be cut.Six cases took PTCD treatment.Five cases discharged without operation or PTCD treatment. One case had taken radiation therapy in the other hospital. Conclusion Diagnosis of hilar cholangiocarcinoma mainly depends on laboratory tests and imaging diagnosis. Surgery is the best treatment. But surgical cure rate is not high and surgical complications can cause death. Intervention including PTCD, can be used as a method of reducing jaundice before surgery or as palliative treatment.