肝门部胆管癌的外科治疗与肝炎病毒感染关系的探讨

Correlation between surgical treatment of hilar cholangiocarcinoma and hepatitis virus infections

目的探讨肝门部胆管癌的外科手术方法及治疗效果以及乙型肝炎和丙型肝炎病毒感染在肝门部胆管癌发病中的作用。方法回顾性分析医院2002年2月-2010年10月收治的80例肝门部胆管癌患者临床资料,对患者手术方式及术后情况进行总结。结果调查的病例中手术根治性切除患者共46例,占57.5%;姑息性切除患者18例,占22.5%;内、外胆管引流患者16例,占20.0%;回访患者65例,其中根治性手术切除患者46例,1、2、3年生存率分别为54.3%、30.4%、15.2%;姑息性手术切除患者18例,1、2年生存率分别为55.6%、6.2%;内、外胆管引流患者16例,1、2年生存率分别为25.0%、12.5%;根治性切除术患者1～3年生存率均高于其他手术方式;所有患者术后发生胆瘘5例、肝功不全3例、应激性溃疡2例,腹腔感染及腹腔出血各1例,术后并发症发生率15.0%。结论乙型肝炎和丙型肝炎病毒感染的肝门部胆管癌恶性程度相对较高,预后可能较差,合理选择手术方式是治疗肝门部胆管癌的主要方法,能够延长患者的最佳生存时间。

OBJECTIVE To explore the effect of surgical treatment on hilar cholangiocarcinoma and the influence of hepatitis B virus infection and hepatitis C virus infection on the incidence of hilar cholangiocarcinoma.METHODS A total of 80 patients with hilar cholangiocarcinoma who enrolled the hospital from Feb 2002 to Oct 2010 were selected as the study objects,the clinical data were retrospectively analyzed,the surgical approaches and postoperative condition were summarized.RESULTS There were 46（57.5%） patients undergoing radical resection and 18（22.5%） patients undergoing palliative resection;there were 16（20.0%） patients undergoing internal and external biliary drainage;there were 65 patients followed return visit including 46 radical resection patients whose survival rates of the first,second and third year were 54.3%,30.4%,and 15.2%,respectively,18 palliative resection patients whose survival rates were 55.6% and 6.2% respectively in the first and second year,and 16 patients undergoing internal and external biliary drainage whose survival rates were 25.0% and 12.5% in the first and second year;the survival rate of the patients undergoing radical resection were higher than that of patients undergoing other surgical approaches during the period of 1-3 years.All of the patients,there were 5 patients with biliar fistula,3 patients with liver dysfunction,2 patients with stress ulcer,1 patient with abdominal infection and 1 patient with abdominal bleeding;the incidence rate of the postoperative complications was 15.0%.CONCLUSION The malignancy of hilar cholangiocarcinoma in the patients with hepatitis B virus infection and hepatitis C virus infection is relatively high,the prognosis is probably poor;the reasonable surgical approach is the main way to treat the hilar cholangiocarcinoma,which can extend the optimal survival time.