肝门部胆管癌的切除与姑息性治疗

The resection and palliative treatment of hepatic portal cholangiocarcinoma.

目的 评价各种外科方法治疗肝门部胆管癌的疗效。方法 收集 1990年 10月～ 1999年 4月肝门部胆管癌 6 8例 ,治疗方法有骨骼化切除或联合肝中央部切除 2 3例 ;局部切除联合左肝叶切除 2例 ;姑息性肝管空肠吻合术 2 5例 ;经十二指肠镜放置胆道内支架 13例 ;经皮肝穿刺放置金属胆道支架 5例。结果 手术后 1个月内死亡 2例 (2 .9% )。随访 5 1例 ,术后生存期 :切除组 11～ 42个月 ,手术内引流组 8～ 18个月 ,经内镜放置内支架组 7～ 13个月 ,经皮肝穿刺放置内支架组 7～ 15个月。各组仍有部分患者生存。结论 根据 Bism uth分型 , 、 型胆管癌切除后效果优良 , 型难以达到根治性切除 ,其切除后生存期与姑息性肝肠吻合术无显著差异。经内镜放置内支架和经皮肝穿刺放置金属内支架均可延长患者生存期。

Objective To evaluate the therapeutic effects of surgical treatments for hepatic portal cholangiocarcinoma.Methods From Oct.1990 to April 1999,68 patients with hepatic portal cholangiocarcinoma were submited to various surgical treatments:skeletonization resection combined with central hepatic resection for 23 cases,local resection with left hepatectomy for 2 cases,palliative hepato biliary anastomoses for 25 cases,biliary stents by duodenum endoscopy for 13 cases,metallic stents by percutaneous placement for 5 cases.Results Postoperative mortality was 2.9% one month after operation.51 cases were followed up and showed that postoperative survival was 11 to 42 months in resection group,8 to 18 months in palliative hepatobiliary anastomoses group,7 to 13 months in stents by endoscopy group,7 to 15 months in stents by percutaneous placement group,respectively.There were some alive up to now in various groups.Conclusion According to Bismuth’s type,resection for type I and Ⅱ have curative effects.Radical resection is difficult for type Ⅲ.The stents by endoscopy and by percutaneous placement can prolong survival.