联合肝叶及肝门部血管切除治疗肝门部胆管癌

Combind liver and hilar vascular resection for hilar cholangiocarcinoma

目的探讨联合肝叶及肝门部血管切除在肝门部胆管癌根治术中的应用。方法同颐性分析解放军总医院肝胆外科2008年1月-2011年12月手术治疗的74例肝门部胆管癌患者的临床资料。74例患者均行手术探查，手术根治性切除33例（44．6％），其中26例联合部分肝切除及血管切除重建；行姑息性切除19例（25．7％）；行内引流或外引流术22例（29．7％）。结果联合肝叶及肝门部血管切除的根治性切除组的中位生存时间为27个月，姑息性手术组的中位生存时间为14个月，引流手术组中位生存时间为9个月；根治性切除术的1、2、3年生存率分别为79％、64％、49％；姑息性手术组1、2、3年生存率分别为56％、25％、19％；引流手术组1、2、3年生存率分别为23％、15％、0。结论根治性切除组的生存率较姑息性手术及引流手术组明显提高，合并肝叶、肝门血管切除可提高肝门胆管癌的手术根治率和生存率；联合肝叶切除有利于肝门胆管癌的根治性切除，提高生存率。

Objective To investigate the value of partial hepatectomy and vascular resection in the treatment of hilar cholangiocareinoma. Methods Seventy four patients with hilar cholangiocarcinoma who underwent hepatectomy of Chinese People＇s Liberation Army from January 2008 through December 2011 were analyzed retrospectively. Results Of the 74 patients, 33 underwent radical resection and 19 palliative resection, 22 received internal or external drainage. In the radical resection group,the median survival time was 27 months, and the overall survival rate at 1, 2 and 3 years were 79% , 64% and 49%. In the palliative resection group,the median survival time was 14 months and the overall survival rate at 1, 2 and 3 years were 56% , 25% , and 19%. In the drainage group, the median survival time was 9 months and the overall survival rate at 1,2 and 3 years were 23% , 15% , 0. Conclusions Hepatectomy combined with hilar vascular resection helps increase survival rate of patients in radical excision of hilar cholangiocarcinoma and Surgical resection is the most elective method for treatment of hepatic hilar cholangiocarcinoma, and the radical resection might improve the prognosis of the patients with hilar cholangiocarcinoma.